Polygyny and women's health in rural Mali

Amazons in Mali? Women's experiences of breast cancer and gender (re)negotiation

Breast cancer is the second most common cancer, with more than 2.31 million cases diagnosed worldwide in 2022. Cancer medicine subjects the body to invasive procedures in the hope of offering a chance of recovery. In the course of treatment, the body is pricked, burned, incised and amputated, sometimes shattering identity and often changing the way women perceive the world. In sub-Saharan Africa, incidence rates are steadily increasing and women are particularly young when they develop breast cancer. Despite this alarming situation, the scientific literature on breast cancer in sub-Saharan Africa is poor and largely dominated by medical literature. Using a qualitative approach and a theoretical framework at the intersection of the sociology of gender and the sociology of the body, we explore the discourse strategies of women with breast cancer in Mali regarding their relationship to the body and to others. Based on 25 semi-directive interviews, we analyse the experiences of these women. Using the image of the Amazon woman, whose struggle has challenged gender because of its masculine attributes, we explore whether these women's fight against their breast cancer could be an opportunity to renegotiate gender relations. The experience of these women is characterised by the deconstruction of their bodies, pain and suffering. The masculinisation of their bodies and their inability to perform certain typically female functions in society (such as cooking or sexuality) challenges their female identity. The resistance observed through the sorority, discreet mobilisation and display of their bodies does not seem to be part of a renegotiation of gender relations, but it does play an active role in women's acceptance of the disease and their reconstruction.

Reliability and validity of a perinatal depression screening instrument in rural Mali

Background

In order to reduce the burden of perinatal depression in low- and middle-income countries, health systems must be able to identify and treat women suffering from depression. The objective of our study was to develop a locally valid and reliable screening instrument for use in identifying pregnant women and mothers of young children with a local depression syndrome, dusukasi, in rural Mali.

Methods

We administered a locally adapted screening instrument containing items from the Edinburgh Postpartum Depression Scale (EPDS) and Hopkins Symptom Checklist (HSCL-25) to 180 pregnant women and mothers of children under age 2 in Sélingué, Mali to assess the instrument's psychometric properties and validity. Item Response Theory was used to develop an abbreviated version of the measure and the validity and psychometric properties of this shortened version were compared with the full-length scale.

Results

The full 28-item scale exhibited a single factor structure with good internal consistency (Cronbach's alpha = 0.92). Women who self-identified as suffering from dusukasi (n = 87) in a known groups analysis to assess construct validity had significantly higher depression and anxiety symptom scores (p < 0.0001) and functional impairment scores (p < 0.0001) compared to women not reporting dusukasi (n = 93). The shortened 16-item scale performed as well as the full scale in identifying women with dusukasi.

Conclusions

Construct validity of our adapted screening instrument was supported for identifying dusukasi in rural Malian women. Our methodology can be applied in other settings to develop similarly valid screening instruments for perinatal depression.

Men's experiences of antenatal care services in low-income and middle-income countries: A qualitative systematic review

BACKGROUND

Men's involvement in antenatal care is critical for the family's overall well-being, yet remains low in many low-income and middle-income countries. The goal of this study was to consolidate and synthesize currently available literature on men's experiences of antenatal care services in low-income and middle-income countries.

METHODS

PubMed, CINAHL, Embase, PsycINFO, and Scopus were searched through December 2020. Qualitative studies were included exploring the antenatal care experiences of men whose pregnant partners utilized antenatal care services, regardless of ethnicity, race, and education levels. Studies examining men's participation in antenatal care that specifically focused on certain conditions such as the human immunodeficiency virus, known pregnancy complications, as well as contraception/fertility treatment, were excluded. Quality appraisal of the included studies was conducted using the Critical Appraisal Skills Program checklist, and Sandelowski and Barroso's two-step approach was used to meta-summarize and meta-synthesize the extracted data.

RESULTS

Four themes were derived from the 27 studies included: (a) Factors enabling men's participation in antenatal care; (b) Barriers affecting men's participation in antenatal care; (c) Men's self-perceived care roles; and (d) Recommendations to improve men's involvement.

CONCLUSIONS

Men's involvement in antenatal care depended on community perceptions, traditional gender roles, and work commitments. Although men often regarded antenatal care services as exclusive to women, some expressed their willingness to participate. Current findings highlight the need for community educational programs, male role models, and training of healthcare providers to improve men's participation.

Stressful life experience of the first married women in polygamous families in Gedeo zone, South Ethiopia: a qualitative study, 2021

INTRODUCTION

Polygamy is commonly referred to as the union of a man with multiple women or the practice of having more than one wife at a time. In Ethiopia, polygamy has practiced in all regions. In particular, the stress of polygamous family life predisposes mothers to psychological problems. Being a serious public health issue, the stressful experience among polygamous women was not known in Ethiopia.

AIM

To explore a stressful life experience among first married polygamous women in Gedeo Zone, South Ethiopia, 2021.

METHODS

This study was conducted using a phenomenological study approach from February 20-30, 2021. A purposive sampling method was used and an in-depth interview was conducted. Data were collected from 13 first married women from polygamous.

FINDINGS

Three themes emerged from the study including reaction to polygamy, socio-economic challenges in polygamy, and bonds of families in polygamy families. The finding indicated that the status of life experience among first married women in a polygamous family was stressful. They experienced various degrees of psychological difficulties including anger, mistrustfulness, emotional distress, loneliness, emptiness, unhappiness, and lack of intimacy with their husbands.

CONCLUSION AND RECOMMENDATIONS

This study highlighted how polygamy is a complex issue and common practice in the Gedeo zone. There has to be a mechanism for serious follow-up to educate women properly. A long-lasting measure to empower women in the economy, social, political, and creating a level of consciousness to resist polygamy is important.

Exploring Strategies for Investigating the Mechanisms Linking Climate and Individual-Level Child Health Outcomes: An Analysis of Birth Weight in Mali

The goal of this article is to consider data solutions to investigate the differential pathways that connect climate/weather variability to child health outcomes. We apply several measures capturing different aspects of climate/weather variability to different time periods of in utero exposure. The measures are designed to capture the complexities of climate-related risks and isolate their impacts based on the timing and duration of exposure. Specifically, we focus on infant birth weight in Mali and consider local weather and environmental conditions associated with the three most frequently posited potential drivers of adverse health outcomes: disease (malaria), heat stress, and food insecurity. We focus this study on Mali, where seasonal trends facilitate the use of measures specifically designed to capture distinct aspects of climate/weather conditions relevant to the potential drivers. Results indicate that attention to the timing of exposures and employing measures designed to capture nuances in each of the drivers provides important insight into climate and birth weight outcomes, especially in the case of factors impacted by precipitation. Results also indicate that high temperatures and low levels of agricultural production are consistently associated with lower birth weights, and exposure to malarious conditions may increase likelihood of nonlive birth outcomes.

Polygyny and Intimate Partner Violence in Mozambique

Polygyny has shown a positive association with intimate partner violence (IPV), yet the nature and mechanisms of this association are not well understood. This study uses data from rural Mozambique to distinguish women in polygynous unions by rank and co-residence. Findings show that senior wives report higher rates of violence than their junior-wife and monogamously married counterparts. At the same time, no difference is detected between junior wives and women in monogamous marriages. Additionally, the analysis finds that polygynously married women living away from their co-wives report higher rates of violence than both women co-residing with co-wives and women in monogamous unions, while the difference between the latter two categories is not statistically significant. However, the results also indicate that senior wives living away from their co-wives face particularly high risks of violence. These findings illustrate the social complexity of polygynous marriages and resulting differential vulnerabilities of women in them.

Sense of coherence among Bedouin women in polygamous marriages compared to women in monogamous marriages

We compared sense of coherence (SOC) among Bedouin women in polygamous with those in monogamous marriages. SOC is a global orientation toward life as comprehensible, manageable, and meaningful, and is derived from generalized resistance resources that promote effective coping in stressful life situations. Strong SOC may be a resource for strengthening resilience and promoting health. We administered questionnaires to 464 Indigenous Arab Bedouin women (ages 18-49 years) in 2008-2009 using the 13-item SOC questionnaire. Contrary to our hypothesis, SOC was higher among women in polygamous compared to monogamous marriages. Husband's education, husband's abandonment of the household, living in unrecognized villages, and low mastery (perception of one's ability to control life situations) were associated with higher SOC. These results might suggest that polygamy may provoke new coping mechanisms among women as they reappraise life amidst low mastery, accept cultural norms, and marshal new resources, thereby increasing key elements of SOC, including comprehensibility, manageability, and meaningfulness. Interventions and services seeking to empower women in polygamous marriages should build on their resilience.

An Integrated Approach to Increasing Women's Empowerment and Reducing Domestic Violence: Results of a Cluster-Randomized Controlled Trial in a West African Country

OBJECTIVE

This is the first experimental study testing the effects of an economic intervention alone and in combination with a family-focused component, on women's empowerment status and family violence in Burkina Faso.

METHOD

The three-arm cluster randomized controlled trial with baseline and one-year follow-up included 360 ultra-poor married women from 12 villages. Villages were randomized to the three study arms: economic intervention for women (Trickle Up/TU), a combination of economic intervention and family coaching (Trickle Up Plus), and waitlist (Control arm). Analysis utilized repeated-measures mixed effects regressions.

RESULTS

Compared to the control group, there was a significant improvement in both the TU arm and the TU Plus arm in women's financial autonomy and in quality of marital relationships. In addition, women in both intervention arms reported a significant reduction in emotional spousal violence in the past year, with the effect size greater for the combined intervention (TU group OR=0.28, 95% CI 0.10,0.82 p=0.02 and TU+ group OR=0.19, 95% CI 0.06,0.64, p=0.007).

CONCLUSIONS

Economic intervention shows benefits that go beyond changes in financial wellbeing and may increase women's status and improve family relationships. Integrating psychosocial components with economic strategies may be more effective for improving women's empowerment status in West Africa.

Assessment of Contraceptive Use by Marriage Type Among Sexually Active Men in Nigeria

Marital status, from the perspective of men (and especially sexually active men), as a potential factor that influences contraceptive use for the purposes of fertility control, has received little consideration in the scientific literature. This study thus assesses contraceptive use among sexually active men occupying different marital statuses. The study employed the 2013 Nigeria Demographic and Health Survey dataset. Using a total sample of 11,476 weighted sexually active men, the study revealed that 30% of the sampled population were currently using contraceptives, with condom as the dominant method (65.9%). The unadjusted odds of contraceptive use was significantly higher (9.4; confidence interval [8.1, 10.9]) among single men than married. Other factors include wealth, educational attainment, ethnicity, region, religion, and age. The study concludes that there are significant differences in contraceptive use between the single and married men and, therefore, recommends that policy and programs be put in place to promote consistent use of contraceptives among married men in Nigeria.

Food insecurity and family structure in Nigeria

The article explores a series of questions and hypotheses related to polygynous family structures and both household and individual-level food security outcomes, using the World Bank Living Standards Measurement Survey data from Nigeria, collected in 2011, 2013 and 2015. A Correlated Random Effects (CRE) model is used to examine the relationship between polygyny and household-level food security, and the degree to which it is mediated by household wealth, size, and livelihood. A Household Fixed Effect model is employed to explore whether a mother’s status as monogamous versus polygynous relates systematically to her child’s health, and also whether child outcomes of senior wives are better than outcomes of junior wives within polygynous households. At the household level, polygynous households are found to have better food security outcomes than monogamous households with differences in household composition and agricultural livelihood as potential explanatory mechanisms. At the individual level, however, children of polygynous mothers have worse nutrition outcomes than children of monogamous mothers in the long run. Within polygynous households, children of junior wives appear to have better nutritional outcomes in the long run, compared to children of more senior wives.

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The article explores a series of questions and hypotheses related to polygynous family structures and both household and individual-level food security outcomes.

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At the household level, food security is proxied by Food Consumption Scores and Reduced Coping Strategies. At the individual level, food security is proxied by child anthropometric measures- height for age (HAZ) and weight for height (WHZ).

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Three waves of the World Bank Living Standards Measurement Survey data from Nigeria, collected in 2011, 2013 and 2015, are used for the analyses. A Correlated Random Effects (CRE) model and a Household Fixed Effect model are the empirical techniques used to examine these relationships.

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At the household level, polygynous households are found to have better food security outcomes than monogamous households with differences in household composition and agricultural livelihood as potential explanatory mechanisms. At the individual level, however, children of polygynous mothers have worse nutrition outcomes than children of monogamous mothers in the long run. Within polygynous households, children of junior wives appear to have better nutritional outcomes in the long run, compared to children of more senior wives.

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Wealth and livestock ownership are positively associated with food security at the household level, while the presence of economic shocks is negatively correlated with food security. At the child level, the age of mothers, higher mothers’ education and livestock ownership are all positively associated with child nutrition.

Nutritional vulnerability: An assessment of the 2010 feeding food programme in Mbire district, Zimbabwe, and its impact on pregnant women

Malnutrition contributes significantly to Zimbabwe's high maternal mortality rate. The prevalence of malnutrition among vulnerable pregnant women in the Mbire district of Zimbabwe was studied to establish why they remained vulnerable despite benefiting from the Vulnerable Group Feeding Programme, a subsidiary of the World Food Programme. A case study on the demographic characteristics, nutritional provision of the programme and the vulnerable pregnant women benefiting from the programme was conducted. One hundred women were purposively sampled at health centres in the district. A two-stage sampling procedure was then utilised to select the most food-insecure wards. The two most food-insecure wards, namely Angwa and Chapoto, were chosen because of their proximity to each other. A questionnaire was administered to the pregnant women to collect their demographic information. Practising nurses at the health centres determined the women's nutritional status and anthropometrics, and they also assessed the food baskets. Permission to conduct the study was obtained from the relevant authorities. The results indicated that the food hamper provided by the World Food Programme was complementary food aid given to all vulnerable members of the community regardless of the nutritional demands. The supplements that the pregnant women received were also inadequate to cater for their nutritional needs or those of the foetuses. It was therefore recommended that the government, through the Ministry of Health, should make more provisions available for vulnerable pregnant women in order to reduce the risks facing pregnant women in the country.

Social and cultural barriers to husbands' involvement in maternal health in rural Gambia

Introduction

While many studies have documented a number of socio-cultural barriers to male involvement in maternal health, in The Gambia very little information is known about the social and cultural practices that characterized male involvement in maternal health. This study aims to explore some of the underlying social and cultural factors affecting husbands’ involvement in maternal health issues pertaining to pregnancy and delivery in rural Gambia.

Methods

Five focus group discussions and six in-depth interviews were conducted among rural men and traditional birth attendants in five areas of rural Gambia. The discussion was directed to the roles of male partners in pregnancy and delivery and the difficulties they face regarding taking care of their wives. The data resulting from the discussion was audio-recorded, transcribed verbatim, and analyzed thematically.

Results

In general, rural Gambian men and traditional birth attendants (TBAs) reported that husbands’ involvement in maternal health is highly desirable, but is influenced by many factors, such as the traditional conceptualization associated with pregnancy and delivery as women’s domain. In addition, many men do not believe that pregnancy chores warrant their efforts compared to other competing social responsibilities. This issue may be more complicated in polygamous marriages where there is rivalry among co-wives and in neighborhoods where men who help with house chores may be subjected to mockery.

Conclusion

These findings suggest that husbands’ involvement in maternal health in The Gambia is influenced by the prevailing social and cultural practices of gender role and norms, which are also at the root of maternal health problems.

Social and Cultural Factors Affecting Maternal Health in Rural Gambia: An Exploratory Qualitative Study

BACKGROUND

The high rate of maternal mortality reported in The Gambia is influenced by many factors, such as difficulties in accessing quality healthcare and facilities. In addition, socio-cultural practices in rural areas may limit the resources available to pregnant women, resulting in adverse health consequences. The aim of this study is to depict the gender dynamics in a rural Gambian context by exploring the social and cultural factors affecting maternal health.

METHODS AND FINDINGS

Five focus group discussions that included 50 participants (aged 15-30 years, with at least one child) and six in-depth interviews with traditional birth attendants were conducted to explore perceptions of maternal health issues among rural women. The discussion was facilitated by guides focusing on issues such as how the women perceived their own physical health during pregnancy, difficulties in keeping themselves healthy, and health-related problems during pregnancy and delivery. The data resulting from the discussion was transcribed verbatim and investigated using a qualitative thematic analysis. In general, rural Gambian women did not enjoy privileges in their households when they were pregnant. The duties expected of them required pregnant women to endure heavy workloads, with limited opportunities for sick leave and almost nonexistent resources to access prenatal care. The division of labor between men and women in the household was such that women often engaged in non-remunerable field work with few economic resources, and their household duties during pregnancy were not alleviated by either their husbands or the other members of polygamous households. At the time of delivery, the decision to receive care by trained personnel was often beyond the women's control, resulting in birth-related complications.

CONCLUSIONS

Our findings suggest that despite women's multiple roles in the household, their positions are quite unfavorable. The high maternal morbidity and mortality rate in The Gambia is related to practices associated with gender inequality.