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.

As always please feel free to leave your comments.

2016-2017 UN Women Call for Applications – Champions for Change

UN Women's Empower Women is seeking applications from dynamic and creative women/girls and men/boys from all over the world to champion women’s economic empowerment. Apply now to become a global Champion for Change.

Who is eligible? Individual women/girls and men/boys from different professional backgrounds and skill sets. Students are also encouraged to apply. Applicants who are younger than 18 years old at the time of application will need to provide parents approval and consent.

What are the benefits? You will work closely with the Empower Women team at UN Women on a personal or group project; be visible and get recognized for your contributions in front of an audience of almost 1,000,000 people from more than 190 countries; and be able to network with 17,000 peers and experts. You will also have the opportunity to acquire new knowledge and learn skills (through webinars, online discussions, blog posts, and much more). 

What will a Champion do? You will be expected to use your expertise, skills, and knowledge to promote women’s economic empowerment online and offline. You will be able to actively participate and lead online discussions; contribute blog posts; share relevant resources; invite networks to join; and explore innovative tools and solutions for women’s economic empowerment; and develop a personal or group project to empower women online and in your community.

For more information on how to apply, go here

Please feel free to share any opportunities you find.

Article gems: Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed

Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.

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Discussion

Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented.

Summary

We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

This is the abstract of a paper titled: 

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

"Article gems" is a new series of posts on Natasha's health watch, highlighting important research papers. Feel free to email me if you find interesting articles that could be part of the series. 

The neglected rural dwellers and maternal mortality in Nigeria

The type of women most underserved by the limited government programmes and provisions available were clearly the women with low socioeconomic status, living in rural regions. They tend to be mainly helpless, due to their depth of poverty and lack of basic amenities. Also, they are more culturally oriented, more likely to place cultural practices and beliefs highly.

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More than one decade after the launch of the Safe Motherhood Initiative, the burden of maternal mortality still takes a heavier toll in the rural dwellers compared to their urban counterparts (Ugwuoke et al., 2015). This is most likely because of the reported underutilisation of skilled birth attendants during pregnancy and delivery. The rural women often seem invisible, they have limited access to infrastructural development, low education and income levels (Ugwuoke et al., 2015). The effectiveness of interventions should equally depend on the focus on the issue of the rural dwellers otherwise they may have limited effects if they don’t tender to the needs of the underserved population. 

The principal means of survival for these rural women are farming and agriculture (Fabiyi and Akande, 2015). If maternal death interventions are to be efficient, the women have to be empowered to make effective decisions especially those requiring finance (e.g., hospital registration, transport to infrastructure and healthy diets). To reduce the women’s poverty level, some states in Nigeria have implemented poverty alleviation through agriculture. Bello and Ashimolowo (2014) reported that the women who participated in the agricultural empowerment projects in Ogun State, Nigeria stated that such programs had a positive impact on their balanced emotion, income, business expansion, and access to credit facilities. Nlerum et al. (2012) reported that majority of the rural women in Eleme community (Rivers State) stated that they had no access to agricultural information and technologies (e.g., such as poultry production, snail rearing etc). But the few respondents who had access to information reported that this raised their farm productivity level (Nlerum et al., 2012). Implications of this are that using less expensive empowerment techniques such as transferring agricultural technology knowledge may potentially increase the Rivers State women productivity rate, thereby, placing them in a better position financially to support proper health care decision-making.

Education and residential area were other influencing factors in the women’s choice of health care provider, their choice on the decision to self-medicate or not, the fear of caesarean section and their general health care seeking behaviour. Studies have shown that women’s formal educational is the most potent tool for the reduction of the Nigerian maternal mortality rate (Igberase, 2009; Moore et al., 2011; British Council, 2012). Unfortunately, some studies have also reported that the Nigerian economy since its independence in 1960 has marginalised the benefits of education (Ikeako et al., 2006). Since most women with low socio-economic backgrounds can not afford to get a proper education, the potential key is in the stimulation of these women to attend health facilities by relaying critical risk communication and using effective communication strategies. Importantly, if communication is successful, to ensure that these women continue proper health care practices, the services and facilities should be made equally services accessible and affordable (Wasabi, 2013).

Please feel free to discuss and comment.