Psychological, and sociological understanding of the decision-making process of women of child-bearing age.

Research has indicated that individuals can use some combination of two modes of thinking: an intuitive and an analytical mode in making decisions (Slovic et al., 2004; Rusou et al., 2013; Ayal et al., 2015). Decisions are made intuitively when they are made quickly, and may rely mostly on heuristics, or mental shortcuts, which sometimes leads to biassed decisions. Conversely, the analytical mode tends to be favoured when an individual has time to analyse data, and assess available options for the best decision.

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Using these two modes of thinking, one can infer that women of childbearing age from the general public, who have limited time, expertise and, resources to evaluate a maternal health risk assessment may rely upon an intuitive mode of decision-making. Conversely, policy makers, maternal health experts and professionals equipped with the necessary resources to conduct a risk assessment, and logically make their decisions ought to favour the analytical mode of thinking. However, care must be taken in perceiving that people, whether experts or lay individuals, rely solely on the analytical or the intuitive way of thinking when making judgements and taking decisions. As Slovic et al. (2004) expressed, rationality is not only a product of the analytical mind but the intuitive mind as well.

Psychology provides one framework for understanding how different people may perceive and react to risks, but sociology has offered another approach for understanding individual risk perception and risk attitudes. The variety of risk perspectives of women of childbearing age may be due to their different worldviews as identified in cultural theory literature (Dake, 1991; Oltedal et al., 2004; Tsouhou et al., 2006). 

Cultural theorists make a distinction between worldviews (shared mental representations, values and general social, cultural and political attitudes held by a group of individuals) and social relations (patterns of social interaction between people and or social organisation) (Wildavsky and Dake, 1990). Studies (Peters and Slovic, 1996; Oltedal et al., 2004; Tsouhou et al., 2006) have summarised a range of ‘ideal type’ worldviews categories as follows:

 Heirarchists:  These individuals place an emphasis on the natural order of society, and preservation, and the perseverance of this order.

 Egalitarians: This group of people fear any development that may increase inequalities amongst people.

Individualists: They fear things that have the potential to hinder their individual freedom.

Fatalists: They take a minor part in social life, are resigned to tight controls on their behaviour and have a “why bother’ attitude toward risks

Thus, hierarchists, egalitarians, individualists, and fatalists may each respond differently to evidence of the risk of maternal mortality and act accordingly:

“…an understanding of who fears what and why requires serious attention to the political, historical, and social context in which risks are framed and debated...mental models of risk are not solely matters of individual cognition, but also correspond to worldviews entailing deeply held beliefs and values regarding society, its functioning, and its potential fate” (Dake, 1991, p62).

Understanding the perception of stakeholders (lay citizens and experts) of maternal health is essential to an improvement of health services and women’s acceptability of intervention programmes. In the context of the laywomen, a cultural theory understanding of their worldview could be interpreted using the following ideal types: that hierarchists tend to trust experts, doctors, and those in authority. They should support and trust hospitals and health centres, as long as the government appropriately legitimises them. Egalitarians should most likely display distrust to the experts and be concerned/wary of interventions of experts, especially if there is a sense of inequality. Individualists should be most concerned about impositions of constraining regulations (e.g. ban on traditional health practices and cultural practices like female genital mutilation). Finally, the fatalists would possess a “Que sera sera” or ‘why bother’ attitude about their maternal health, hence leaving their health outcome to fate.

This theory, could have important implications for maternal health policymaking and risk communication, revealing that ‘one-size-fits-all’ universal policies and interventions may fail. In summary, the psychological and sociological perspectives on risk perception suggest that lay citizens interpret a particular risk and make decisions towards that risk using several intuitive and analytical processes. The psychometric paradigm points to cognitive factors as the causes of differences in perceptions and attitudes exhibited by stakeholders, and the preferred remedy is, not surprisingly, public education through risk communication (Slovic, 1986). The importance of social relations, either involving individuals or social organisations has been highlighted, indicating the importance of communication. Igboanugo and Martin (2011) recommended that providing critical information to women on how to identify risk factors during pregnancy was important. They also considered that health ministers responsible for maternity service provision should be encouraged to hear the voices of the people they represent. Overall, communication plays a vital role in addressing the individual/ community perception and worldviews.

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