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Gendered norms of responsibility: reflections on accountability politics in maternal health care in Malawi

Overview of attention for article published in International Journal for Equity in Health, September 2018
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4 tweeters

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3 Dimensions

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Title
Gendered norms of responsibility: reflections on accountability politics in maternal health care in Malawi
Published in
International Journal for Equity in Health, September 2018
DOI 10.1186/s12939-018-0848-3
Pubmed ID
Authors

Elsbet Lodenstein, Kyra Pedersen, Kondwani Botha, Jacqueline E. W. Broerse, Marjolein Dieleman

Abstract

This paper aims to provide insights into the role of traditional authorities in two maternal health programmes in Northern Malawi. Among strategies to improve maternal health, these authorities issue by-laws: local rules to increase the uptake of antenatal and delivery care. The study uses a framework of gendered institutions to critically assess the by-law content, process and effects and to understand how responsibilities and accountabilities are constructed, negotiated and reversed. Findings are based on a qualitative study in five health centre catchment areas in Northern Malawi. Data were collected using meeting observations and document search, 36 semi-structured individual interviews and 19 focus group discussions with female maternal health service users, male community members, health workers, traditional leaders, local officials and health committee members. A gender and power sensitive thematic analysis was performed focusing on the formulation, interpretation and implementation process of the by-laws as well as its effects on women and men. In the study district, traditional leaders introduced three by-laws that oblige pregnant women to attend antenatal care; bring their husbands along and; and to give birth in a health centre. If women fail to comply with these rules, they risk being fined or denied access to maternal health services. The findings show that responsibilities and accountabilities are negotiated and that by-laws are not uniformly applied. Whereas local officials support the by-laws, lower level health cadres' and some community members contest them, in particular, the principles of individual responsibility and universality. The study adds new evidence on the understudied phenomenon of by-laws. From a gender perspective, the by-laws are problematic as they individualise the responsibility for maternal health care and discriminate against women in the definition and application of sanctions. Through the by-laws, supported by national policies and international institutions, women bear the full responsibility for failures in maternal health care, suggesting a form of 'reversed accountability' of women towards global maternal health goals. This can negatively impact on women's reproductive health rights and obstruct ambitions to achieve gender inequality and health equity. Contextualised gender and power analysis in health policymaking and programming as well as in accountability reforms could help to identify these challenges and potential unintended effects.

Twitter Demographics

The data shown below were collected from the profiles of 4 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 32 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 32 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 8 25%
Researcher 6 19%
Student > Bachelor 5 16%
Student > Ph. D. Student 4 13%
Student > Doctoral Student 2 6%
Other 4 13%
Unknown 3 9%
Readers by discipline Count As %
Social Sciences 14 44%
Nursing and Health Professions 5 16%
Medicine and Dentistry 4 13%
Engineering 3 9%
Business, Management and Accounting 1 3%
Other 1 3%
Unknown 4 13%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 25 September 2018.
All research outputs
#7,637,101
of 13,555,083 outputs
Outputs from International Journal for Equity in Health
#771
of 1,123 outputs
Outputs of similar age
#132,010
of 265,025 outputs
Outputs of similar age from International Journal for Equity in Health
#1
of 1 outputs
Altmetric has tracked 13,555,083 research outputs across all sources so far. This one is in the 42nd percentile – i.e., 42% of other outputs scored the same or lower than it.
So far Altmetric has tracked 1,123 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 8.6. This one is in the 29th percentile – i.e., 29% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 265,025 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 48th percentile – i.e., 48% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them