title: Tracing shadows: How gendered power relations shape the impacts of maternal death on living children in sub Saharan Africa.
abstract: Driven by the need to better understand the full and intergenerational toll of maternal mortality (MM), a mixed-methods study was conducted in four countries in sub-Saharan Africa to investigate the impacts of maternal death on families and children. The present analysis identifies gender as a fundamental driver not only of maternal, but also child health, through manifestations of gender inequity in household decision making, labor and caregiving, and social norms dictating the status of women. Focus group discussions were conducted with community members, and in depth qualitative interviews with key-informants and stakeholders, in Tanzania, Ethiopia, Malawi, and South Africa between April 2012 and October 2013. Findings highlight that socially constructed gender roles, which define mothers as caregivers and fathers as wage earners, and which limit women's agency regarding childcare decisions, among other things, create considerable gaps when it comes to meeting child nutrition, education, and health care needs following a maternal death. Additionally, our findings show that maternal deaths have differential effects on boy and girl children, and exacerbate specific risks for girl children, including early marriage, early pregnancy, and school drop-out. To combat both MM, and to mitigate impacts on children, investment in health services interventions should be complemented by broader interventions regarding social protection, as well as aimed at shifting social norms and opportunity structures regarding gendered divisions of labor and power at household, community, and society levels.
authors.affiliation: Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Franςois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA. Electronic address: ayamin@hsph.harvard.edu.
authors.forename: Alicia Ely
authors.initials: AE
authors.lastname: Yamin
authors.affiliation: Partners In Health-Abwenzi Pa Za Umoyo, Neno, Malawi.
authors.forename: Junior
authors.initials: J
authors.lastname: Bazile
authors.affiliation: HIV/AIDS, STI and TB Unit, Human Sciences Research Council, Durban, South Africa.
authors.forename: Lucia
authors.initials: L
authors.lastname: Knight
authors.affiliation: Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Mitike
authors.initials: M
authors.lastname: Molla
authors.affiliation: Franςois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Maistrellis
authors.affiliation: Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Franςois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Leaning
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D002648:Child; D000067576:Child Health; D054540:Child, Orphaned; D003906:Developing Countries; D005220:Fathers; D005260:Female; D017144:Focus Groups; D005783:Gender Identity; D006296:Health Services / Q000600:supply & distribution; D006801:Humans; D008297:Male; D063130:Maternal Death; D008428:Maternal Mortality; D011247:Pregnancy; D036301:Qualitative Research; D066262:Social Norms; D012959:Socioeconomic Factors
keywords: Child health; Ethiopia; Gender roles; Malawi; Masculinities; Maternal mortality; South Africa; Tanzania