Bargaining for maternal health : partnerships and families in urban Mexico
Maternal health in developing countries is a longstanding public concern with
a marked orientation to problems of access to and quality of medical services.
Debates on reproductive rights have led not only to the enhancement of
conditions for pregnant women's health but also to a new understanding of
previously disregarded micro-factors which undermine women's health. This
thesis investigates maternal health at household level throughout pregnancy
by focusing on 'maternal health behaviours' and 'pregnancy care' developed
by each household member. A gender analysis on the different perceived
roles, interests and contributions of household members highlights elements
of conflict and cooperation in intra-household relations. Within such
cooperative conflict the importance of pregnancy care is assessed. A
longitudinal perspective on contemporary events in pregnancy led to the
application of a case study approach.
The exploratory character of this research in the absence of similar studies called
for the identification of variations in pregnancy care. It was assumed that
conjugal status mediates the bargaining process as well as pregnancy care.
Eleven case studies included five types of relationship: long-term relationships;
young couples; stepfamilies; reunited former couples and single women.
However, subsequent acknowledgment of Mexico's tight family networks made
me realize that conjugal contracts and pregnancy care are affected by how
couples connect with their extended families. Pregnancies on the site are often
unplanned and frequently trigger marital bargaining. Again, conjugal status is
related to female bargaining power and the issues that the women brought to
bargaining. The women's behaviour in seeking health-care varied according to
the degree to which they could afford to mix private and public medical care and
their sense of what medical services were appropriate at different points in the
pregnancy. Poverty and social practices concerning pregnancy on the site
highlighted a patriarchal system with harsh conditions and insecure pregnancy
care for the women studied.