The Influence of Intrafamilial Power on Maternal Health Care in Mali: Perspectives of Women, Men, and Mothers-in-Law

Research and programs have traditionally sought to understand and influence maternal health by focusing on the knowledge, attitudes and practices of recently-pregnant women. Yet, women are often not the decision-makers. In this innovative study, we analyze data collected from women, their husbands, and their mothers-in-law to explore the relative influence of each household member on maternal health practices in rural Mali. The analysis modeled indices of eight cultural domains, including traditionality, gender roles, and power. Key outcomes are antenatal care frequency, antenatal care timing, place of delivery, and receipt of postnatal care. Husbands’ preferences and opinions were not significantly associated with any of the outcomes. In contrast, the preferences and opinions of mothers-in-law had strong effects on the maternal health behaviors of their daughters-in-law. These results indicate that interventions focusing only on women are insufficient to advance women’s reproductive health in patriarchal societies such as Mali.