Central theme | Sub-themes | Key findings on gender influences | Implications for post-discharge treatment-seeking, adherence to advice and outcomes |
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Gender related influences at the facility/health system level | Fewer female medical practitioners available in healthcare facilities, esp. in rural areas | -Mothers’ (esp young, rural married mothers’) hesitant to interact with male providers due to socio-cultural and religious norms; reinforced by other household and community members - More rarely: reports and experience of sexual harassment of women by male providers | • Delays in visiting medical practitioners for a mothers’ own health (with implication for her ability to care for a child) • Delays in visiting medical practitioners when a child is sick |
Male caregivers preferring not to stay in the paediatric ward with (re)-admitted children | -Childcare considered primarily in the female domain, including during hospital admission, and many young children are breast-feeding. - Mothers expected to be present in wards, men’s presence can make mothers uncomfortable - Mothers therefore receive more advice than their male counterparts and other family members on children’s feeding, hygiene and medication practices | • Mothers need to get home from admission as soon as possible to complete their other domestic and income earning roles • Families discharge their children against medical advice and resist re-admission • Mothers do not necessarily have the time or power in households on their return from hospital to implement or to share their knowledge with other household members | |
More female than male CHWs in health facilities and in hones | - Some male family members did not value female CHWs’ advice, and some especially opposed their anti- domestic violence work - Some male partners of CHWs did not want their wives entering others’ homes where men are living (concerned about reputation, safety and affairs) | • Female CHWs are a potentially strong support for mothers post hospital discharge. • Potential support pre and post discharged undermined by social norms and undervaluing of CHWs by some | |
Gender related influences at the household/community level | Gendered roles and relations | -Women’s work includes domestic roles and, esp. in urban areas, income earning. Men rarely assist with ‘women’s work’ - Some women, esp. rural young women from conservative religious homes, are not allowed to move without male escorts outside the home - Women traditionally feed themselves last in homes, and miss out on food if necessary -Women’s body shape sometimes more appreciated/admired prior to breast-feeding | • Delays in visiting medical practitioners for a mothers’ own health (with implications for her ability to care for a child needing special support post discharge) • Delays in visiting medical practitioners when a child is sick • Mothers stop breastfeeding out of concern for their body shape or because they are concerned about inadequate breast milk |
Women’s access to household resources, and decision-making power | -Women often have low or no access and control over household resources, sometimes even income they have earned themselves -Deliberate intention among some men to maintain leadership at home; ‘disobedient’ women risk social/physical abuse, and divorce -Divorced/separated women can be seen as a burden in their parents’ own home, and face particular challenges accessing funds from children’s fathers | • Default decision-makers during child illness often the child’s father and elder women (especially mother in laws) – may have a preference for shop drugs or healers • Difficult for an especially young woman to go against her husband’s choices re feeding and treating children; fears being blamed for any unintended adverse events | |
‘Boy preference’ | - Much discussion about boy preference linked to their expected future income-earning roles, provision for their parents, and continuation of the father’s lineage - Some women are more respected for giving birth to a boy, and may face stigma or divorce if they do not give birth to a son. - Birth spacing may be reduced if women are trying to give birth to a boy | • Mothers may be better supported by children’s fathers with regards to pre and post discharge food provision and treatment-seeking for boys compared to girls • Mothers may be under greater to discharge their girl children from hospital against medical advice |