TY - JOUR
T1 - Women who break the rules
T2 - Social exclusion and inequities in pregnancy and childbirth experiences in Zambia
AU - Sochas, Laura
N1 - Funding Information:
The UK Economic and Social Research Council funded this study as part of a doctoral grant. I gratefully acknowledge the generous guidance, abundant comments and editing provided by my PhD supervisors, Dr Tiziana Leone and Prof Ernestina Coast. Three anonymous reviewers provided many constructive and thoughtful comments that greatly improved the paper. The interviewing and transcription for this study was expertly carried out by Ruth Chipoya and Martha Njovu. I gratefully acknowledge Innovations for Poverty Action and the Alliance Française for hosting me and my research assistants during training and transcription. I thank all participants of the LSE Global Health Initiative Peer Reading Group, especially Philipa Mladovsky for recommending Naila Kabeer's social exclusion framework. I further wish to warmly thank Collins Chansa, Virginia Simushi, Brivine Sikapande, Dr Yusuf Ahmed, Dr Mabvuto Zulu, Dr Bellington Vwalika, and Dr Mary Nambao for facilitating the study and sharing their views and expertise, as well as the Zambian Ministry of Health and the Mansa District Health Office for allowing me to conduct this research. Most of all, I gratefully acknowledge the time and contributions made by the participants in this study.
Publisher Copyright:
© 2019 The Author
PY - 2019/7
Y1 - 2019/7
N2 - 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.
AB - 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.
KW - access to care
KW - disrespectful care
KW - health inequities
KW - maternal health
KW - norms
KW - power
KW - social exclusion
KW - Zambia
UR - http://www.scopus.com/inward/record.url?scp=85065702711&partnerID=8YFLogxK
UR - https://www.sciencedirect.com/journal/social-science-and-medicine
U2 - 10.1016/j.socscimed.2019.05.013
DO - 10.1016/j.socscimed.2019.05.013
M3 - Article
C2 - 31112919
AN - SCOPUS:85065702711
SN - 0277-9536
VL - 232
SP - 278
EP - 288
JO - Social Science & Medicine
JF - Social Science & Medicine
ER -