Women: Gender Role and Hierarchy

Ashraf (2009), in a Philippine study using an exploratory design posits that women in most developing countries have restricted decision-making abilities that are as a result of differences in gender roles and family social hierarchy. Women's inability to control their own sexual and reproductive health can lead to high fertility rates, frequent unwanted pregnancies and may increase the risk of complications during childbirth. This places women at an increased risk of maternal mortality. Power dynamics within the household can mean that women are unable to take control over their reproductive health, putting them at an increased risk of maternal death.

Yalem (2010) discusses the determinants of antenatal care and skilled birth attendant utilization among the women of Samre Saharti District in Ethiopia. He observes that there is low utilization of maternal healthcare services since husbands and mothers-in-law usually decide for the women on the utilization of antenatal care. Pregnant women always have to get permission from their husbands to seek care during pregnancy.

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Klingberg-Allvin et al. (2012), in their qualitative analysis to identify and synthesize of the non-financial access barriers to maternal health services in Vietnam, conclude that the first and most important duty of a wife is to bear a son to continue with the family lineage and provide spiritual assertion. On the contrary, some other studies also found that women's decision-making power within the family has only a weak or no effect on women's maternal health. For instance, Simkhada, Vanteijlingen and Porter (2008), looked at factors affecting the utilization of antenatal care in developing countries.

They note that women's decision-making power within the family does not determine maternal health. They conclude that the uptake of antenatal care is affected by maternal education, husband's education, marital status, availability, cost, women's employment, household income, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also influenced antenatal care use.

Fotso et al. (2009), while looking at the influence of women's decision- making on maternal health among Nairobi women in Kenya concluded that, education, household wealth, demographic and health covariates had strong relationships with place of delivery but women's decision making was rather a weak determinant. Even though researches on the influence of women's decision-making on maternal health have been conducted in various countries, for instance, Mali, Philippines and Ethiopia, there was need for a study interrogating determinants of maternal health in Ainamoi Constituency due to variation in cultures hence the study employed ethnographic research design to establish the relationship between women's decision-making power within the family among the Kipsigis and their utilization of maternal healthcare services.

In a study by Mkhize 2014, the most common sources of knowledge about the use of Traditional Medicines in pregnancy were relatives (82.4%), showing the power of family influence. This finding is similar to other studies which found that older family members were the most common persons who recommended the use of herbal medicines during pregnancy. In this study, some participants reported that they did not know much about Traditional Medicine in pregnancy but were forced or coerced to take TM by a family member. In a study by Ngubeni, women stated that they were forced by mother in laws to use TM in pregnancy (Ethnic groups in South Africa, 2012).