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Table 3 Summary of the gendered nature of household treatment-seeking

From: Applying a gender lens to understand pathways through care for acutely ill young children in Kenyan urban informal settlements

What constitutes gendered power relations How is power negotiated and changed?
Who has what Who does what Who decides How are values defined Household level Health system level
Men (and to a lesser extent senior women), had more direct access to financial resources by virtue of being the income-earners. Women (mothers, grandmothers and female neighbours) were the primary carers of children, decision-makers and engagers with the health system during child illness.
Female relatives and neighbours play a key role in influencing perception of the child’s illness cause and advising on ‘suitable’ treatment options.
Where present, men and senior woman such as grandmothers (where they resided in the household), were the primary financial providers including for treatment-seeking.
Mothers were the primary decision-makers for treatment-seeking during child illness, largely informing husbands (where present) for financial provision to seek treatment. Where senior women resided in the household (HH), they also played a key authoritative or advisory role in decisions around child health, illness and treatment-seeking.
In fewer cases, there were consultations and joint decisions between the fathers and mothers
As is typical of the study context, childcare roles and responsibilities were gendered with women being primarily responsible, and caregiving perceived as a female domain.
When children were unwell, some mothers were blamed for failing to meet these responsibilities.
Men’s roles and responsibilities were primarily centred on providing funds.
Older women both within and outside the HH were regarded as wise and considered to have knowledge, and experience in matters of child health. Consequently, they acted as advisors and provided guidance to younger parents.
There appeared to be ‘cooperation’ between spouses when it came to child health; with mothers stating easy access to HH financial resources for treatment-seeking; despite predominantly relying on husbands for financial provision.
Two exceptions were noted, both of which had marital disharmony. In both cases, the mothers drew on extended family support.
Most mothers had autonomy to decide where to seek treatment for their ill children with limited or no consultation.
As younger wives, the two mothers in polygamous unions had to navigate challenging relationships with their older co-wife/ves (who lived elsewhere) and reduced financial support from their spouses.
There were more evident power hierarchies within the health system; particularly between female nurses and mothers. Female nurses were described as often exerting dominant power over mothers resulting in poor interactions and compromising childcare. This was both in the outpatient and inpatient settings but more pronounced in the latter.
Mothers on the other hand negotiated this by exercising subtle agency e.g. by; drawing on each other for support, refusing to attend clinics on days when certain (perceived unfriendly) health workers were on duty, or expressly ‘demanding’ attention when they felt their children were neglected.