title: The influence of intrafamilial power on maternal health care in Mali: perspectives of women, men and mothers-in-law.
abstract: BACKGROUND
  Evidence from diverse settings suggests that women often have limited control over their own reproductive health decisions. To increase uptake of preventive services and behaviors, it is important to understand how intrafamilial power dynamics and the attitudes of women, their husband and their mother-in-law are associated with maternal health practices.
  
  
  METHODS
  In 317 households in two rural districts of central Mali, women who had given birth in the previous year, their husband and their mother-in-law each completed a survey gauging their attitudes toward constructs of gender, power and health. Bivariate and multivariable logistic regression analyses were conducted to identify associations with four maternal health outcomes: antenatal care frequency, antenatal care timing, institutional delivery and postnatal care.
  
  
  RESULTS
  In multivariable analyses, the preferences and opinions of mothers-in-law were associated with the maternal health behaviors of their daughters-in-law. Women's own perceptions of their self-efficacy, the value of women in society and the quality of services at the local health facility were also independently associated with their preventive and health-seeking practices. Husbands' preferences and opinions were not associated with any outcome.
  
  
  CONCLUSIONS
  Interventions focusing on women or couples may be insufficient to advance women's reproductive health in patriarchal societies such as Mali. Future research and programmatic efforts need to address gender norms and consider the influence of other family members, such as mothers-in-law.
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA. darcy.white@emory.edu
authors.forename: Darcy
authors.initials: D
authors.lastname: White
authors.forename: Michelle
authors.initials: M
authors.lastname: Dynes
authors.forename: Marcie
authors.initials: M
authors.lastname: Rubardt
authors.forename: Koman
authors.initials: K
authors.lastname: Sissoko
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
mesh_terms: D000328:Adult; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016901:Intergenerational Relations; D008297:Male; D008302:Mali; D008393:Marriage / Q000523:psychology*; D008427:Maternal Health Services / Q000458:organization & administration*; D008875:Middle Aged; D026684:Personal Autonomy; D011209:Power, Psychological; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult