SummaryThis study is based on a population-based, descriptive questionnaire survey, the objective of which was to elicit the perceptions of women in south-eastern Nigeria on whether possession of economic/household assets by women enhanced their capacity to negotiate reproductive issues with their husbands. The findings show that the respondents believed that possession of economic/household assets by women in their communities might not necessarily increase their negotiation power in their reproductive decision-making. Other factors tend to attenuate the effects of women's possession of economic/household assets on their reproductive bargaining power. Notable among these may be social norms that implicitly arrogate control of the assets owned by the conjugal couple to the man, even when they are bought by the women. Planners of reproductive health intervention projects, policy-makers and researchers need to be aware of such sociocultural specific phenomena, which do not fit with widely held international beliefs.
SummaryThis is a qualitative, descriptive study to explore gender-related factors that influence health seeking for tuberculosis (TB) care by women in Ebonyi State, Nigeria. In-depth interviews based on interview guides were conducted with participants selected through purposive sampling in communities in the state. The results show that gender relations prohibit women from seeking care for symptoms of TB and other diseases outside their community without their husbands' approval. Gender norms on intra-household resource ownership and control divest women of the power to allocate money for health care seeking. Yet, the same norms place the burden of spending on health care for minor illnesses on women, and such repeated, out-of-pocket expenditures on health care at the village level make it difficult for women to save money for use for health care seeking for major illnesses such as TB, which, even if subsidized, still involves hidden costs such as transport fare. The opening hours of TB clinics do not favour their use by most women as they are open when women are usually engaged in income-generating activities. Attending the clinics may therefore entail opportunity costs for many women. People with chronic, infectious diseases such as TB and HIV are generally stigmatized and avoided. Women suffer more stigma and discrimination than men. Stigma and discrimination make women reluctant to seek care for TB until the disease is advanced. Policies and programmes aimed at increasing women's access to TB services should not only take these gender norms that disempower women into explicit consideration but also include interventions to address them. The programmes should integrate flexible opening hours for TB treatment units, including introduction of evening consultation for women. Interventions should also integrate anti-stigma strategies led by the community members themselves.