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Table 6 Gender Framework (power relation and drivers of inequality)

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

Content In households/communities In health services/facilities/system
Who has what? -Husbands, fathers and elders typically have control over resources in households, including income women have earned
-Married women often cannot access household resources, influencing their ability to independently follow hospital and health worker advice
-There are fewer female than male medical practitioners (physicians) employed in (especially rural) health facilities, contributing to some discomfort in women accessing those facilities for themselves and their children.
- Most CHWs are female; some fathers are dismissive of their advice
Who does what? -Women/mothers have multiple domestic tasks in the home, including childcare. Some (especially in urban areas) also earn an income. Traditionally young lactating mothers feed themselves last in a household.
-Especially young mothers may have to hand over child’s care to others in the household after discharge
-Hospitals and health centres are seen as a women’s domain; men generally do not feel comfortable staying in facilities with their children, even if their wife is earning
-Some CHWs are not welcome in homes, particularly where they are seen by men to be undermining their relationship with their wives
How are values defined? - Men generally seen as heads of households and main breadwinners, and women as child carers
- Young women’s views/knowledge on child health etc. generally less valued than men’s and elders; women sometimes blamed for a child’s condition for failing in her ascribed roles
- Boys sometimes seen to have greater potential as breadwinners and future support for the family than girls, and so prioritized over girls in access to food, medicine & treatment
-Linked to the way in which values are defined in households/ communities, caring roles in the health professions are possibly seen as more appropriate and feasible than clinical leadership positions
- Positions which can be isolated or need other family members to accompany the job holder (like postings to rural facilities) can be considered more appropriate for men than women
Who made the decisions? -Husbands and household elders typically made decisions on division of labor in household in relation to children, and on food, medicine and treatment seeking decisions -Husbands and household elders can influence women’s ability to access medical practitioners and CHWs
-There may be greater eagerness or pressure on mothers to get out of hospitals and back to homes where boys are left at home, and where girls are admitted
How is power negotiated and changed -Especially in urban areas, more women are earning an income exposing them to different types of interactions with men and giving some greater decision-making power over treatment-seeking
- Women reported that they were rarely able challenge gender based decision-making norms regarding childcare and treatment because doing so is considered unacceptable socially and culturally.
-Some providers introducing initiatives aimed at easing discomfort of women and their husbands in attending facilities
-Some women are interacting with CHWs in empowerment programmes aimed at supporting greater equity, and less abuse, in homes