How intra-familial decision-making affects women's access to, and use of maternal healthcare services in Ghana: a qualitative study.
How intra-familial decision-making affects women's access to, and use of maternal healthcare services in Ghana: a qualitative study.
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族内决策如何影响妇女在加纳的孕产妇医疗服务的使用和使用：一项定性研究。
DOI：
10.1186/s12884-015-0590-4
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发表时间：
2015-08-15
影响因子：
3.1
通讯作者：
Baatiema L
中科院分区：
文献类型：
--
作者：
Ganle JK;Obeng B;Segbefia AY;Mwinyuri V;Yeboah JY;Baatiema L
一些证据表明，在家庭、家庭和社区环境中，撒哈拉以南非洲妇女对其生殖健康决定的自主权和控制权往往有限。然而，很少有研究探讨家庭内部决策权如何影响妇女获得和使用孕产妇保健服务的能力。本文的目的是研究家庭内部决策如何影响妇女获得和使用孕产妇保健服务的能力。我们进行了12个焦点小组讨论和81个单独的采访，共185个孕妇和哺乳期的母亲在加纳的六个社区。此外，还与医疗保健提供者进行了20次关键线人访谈。Attride-Stirling的专题网络分析框架被用来分析数据。研究结果表明，关于获得和使用熟练的孕产妇保健服务的决策受到丈夫，岳母，传统助产士和其他家庭和社区成员的价值观和意见的强烈影响，而不是个别育龄妇女。在49.2%、16.2%和12.4%的妇女表示她们在最近一次怀孕期间无法获得孕产妇保健服务的情况下，分别由丈夫、婆婆和丈夫加婆婆做出决定。只有2.7%的案件由妇女自己作最后决定。研究结果强调了改善孕产妇保健服务的目标如何通过性别不平等，经济边缘化，社区决策和社会权力的复杂过程，由于妇女缺乏决策自主权而受到破坏。改善妇女利用孕产服务的干预措施应超越妇女个人，以多个层面的不同利益攸关方为目标，包括丈夫和岳母。
There is some evidence to suggest that within the household, family and community settings, women in sub-Saharan Africa often have limited autonomy and control over their reproductive health decisions. However, there are few studies that examine how intra-familial decision-making power may affect women’s ability to access and use maternal health services. The purpose of this paper is to examine how intra-familial decision-making affects women’s ability to access and use maternal health services. We conducted 12 focus group discussions and 81 individual interviews with a total of 185 expectant and lactating mothers in six communities in Ghana. In addition, 20 key informant interviews were completed with healthcare providers. Attride-Stirling’s thematic network analysis framework was used to analyse the data. Findings suggest that decision-making regarding access to and use of skilled maternal healthcare services is strongly influenced by the values and opinions of husbands, mothers-in-law, traditional birth attendants and other family and community members, more than those of individual childbearing women. In 49.2 %, 16.2 %, and 12.4 % of cases in which women said they were unable to access maternal health services during their last pregnancy, husbands, mothers-in-law, and husband plus mothers-in-law, respectively, made the decision. Women themselves were the final decision-makers in only 2.7 % of the cases. The findings highlight how the goal of improving access to maternal healthcare services can be undermined by women’s lack of decision-making autonomy through complex processes of gender inequality, economic marginalisation, communal decision-making and social power. Interventions to improve women’s use of maternity services should move beyond individual women to target different stakeholders at multiple levels, including husbands and mothers-in-law.