Women who break the rules: Social exclusion and inequities in pregnancy and childbirth experiences in Zambia

Research output: Contribution to journalArticlepeer-review

Abstract

Health inequities are a growing concern in low- and middle-income countries, but reducing them requires a better understanding of underlying mechanisms. This study is based on 42 semi-structured interviews conducted in June 2018 with women who gave birth in the previous year, across rural and urban clinic sites in Mansa district, Zambia. Findings show that health facility rules regulating women's behaviour during pregnancy and childbirth create inequities in women's maternity experiences. The rules and their application can be understood as a form of social exclusion, discriminating against women with fewer financial and social resources. This study extends existing frameworks of social exclusion by demonstrating that the rules do not only originate in, but also reinforce, the structural processes that underpin inequitable social institutions. Legitimising the rules supports a moral order where women with fewer resources are constructed as “bad women”, while efforts to follow the rules widen existing power differentials between socially excluded women and others. This study's findings have implications for the literature on reversed accountability and the unintended consequences of global and national safe motherhood targets, and for our understanding of disrespectful maternity care.
Original languageEnglish
Pages (from-to)278-288
Number of pages11
JournalSocial Science & Medicine
Volume232
Early online date14 May 2019
DOIs
Publication statusPublished - Jul 2019

Keywords / Materials (for Non-textual outputs)

  • access to care
  • disrespectful care
  • health inequities
  • maternal health
  • norms
  • power
  • social exclusion
  • Zambia

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