Women's voices in maternal health: autonomy in prenatal care amongst pregnant women

Abstract

Bangladesh has made significant progress after independence and is often seen as a development model for other countries, particularly in closing the gender gap. However, one pressing issue that persists is the high maternal mortality rate among women. Despite recent improvements, maternal health remains a concern. A major reason for this is the underutilization of maternal healthcare services. The key to improving maternal health care utilization is women's autonomy. This dissertation explores the perspectives of pregnant women regarding autonomy during prenatal care. It seeks to understand how pregnant women perceive autonomy in maternal health care and their stance within their families when seeking such care. The study also investigates how these perspectives vary across different generations and occupational backgrounds, shedding light on the influence of age and occupation in shaping perspectives. Additionally, the research delves into the impact of social, cultural, and economic factors on these varying perspectives among different groups of pregnant women aiming to uncover why these variations exist. This qualitative study collected primary data through in-person interviews with pregnant women, healthcare professionals, and NGO experts. The findings reveal that a pregnant woman's perception of autonomy is often linked to the degree of autonomy they experience in their lives. When considering occupational and generational differences, unemployed women, typically homemakers, tend to view autonomy as adaptation or adjustment, while employed women see it as a preexisting privilege. The older generation, those above 50 years old, often did not grasp the concept of maternal autonomy during their pregnancies. Furthermore, cultural influences like media, economic factors such as education and employment, social dynamics within families, and the concept of body ownership all play significant roles in shaping these varying 9 perspectives among pregnant women. To analyze these findings, the study employs Anthony Giddens' theory of "Structuration." This theory helps us understand how women's autonomy is influenced by the rules and resources within a given social structure. Importantly, the study highlights how a woman's autonomy perspective and agency can, in turn, influence these rules and resources. Ultimately, an individual's autonomy can shape their perspective on autonomy itself. Therefore, this dissertation contributes to existing research by focusing specifically on pregnant women's perspectives during prenatal care. It also adds to existing theories by demonstrating how autonomy can be influenced by a structure's rules and resources, and how an individual's autonomy perspective and agency can, in turn, impact these structural elements.