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Table 5 Summary of gender related influences adherence to advice and treatment-seeking guidance following hospital discharge

From: Gender-related influences on adherence to advice and treatment-seeking guidance for infants and young children post-hospital discharge in Bangladesh

Central theme Sub-themes Key findings on gender influences Implications for post-discharge treatment-seeking, adherence to advice and outcomes
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