Also in this issue of International Perspectives on Sexual and Reproductive Health :

"Use of Dual Protection Among Female Sex Workers In Swaziland," by Eileen A. Yam et al.;

"Acceptability and Feasibility of Mifepristone-Misoprostol For Menstrual Regulation in Bangladesh," by Anadil Alam et al.;

"The Incidence of Induced Abortion in Malawi," by Brooke A. Levandowski et al.;

"The Mystery of Missing Female Children in the Caucasus: An Analysis of Sex Ratios by Birth Order," by Marc Michael et al.

Women whose mother-in-law embraces traditional practices and gender attitudes are less likely to have delivered their last birth in a health care institution than those whose mother-in-law does not, according to "The Influence of Intrafamilial Power on Maternal Health Care in Mali: Perspectives of Women, Men and Mothers-in-Law," by Darcy White of Emory University et al. The study, based on data from a CARE Mali maternal health project, also found that these women are less likely than others to have received care from a skilled provider after giving birth.

The study investigated how family power dynamics and the attitudes of women, their husband and their mother-in-law are associated with women's maternal health practices. In general, women reported less use of maternal health care than recommended by the World Health Organization: Some 34% initiated prenatal care in the first trimester, 27% made at least four prenatal care visits, 22% delivered in a health care institution, and 24% received timely postnatal care from a skilled provider. However, the influence of mothers-in-law showed up in several areas.

The researchers looked at 317 households, in two rural districts, in which women had given birth in the previous year. The women, their husband and their mother-in-law each completed a survey gauging their attitudes about gender roles, power and health care. In households where the mother-in-law perceived her son as having greater decision-making power than her daughter-in-law, women were more likely to have delivered their last birth in a health care institution and more likely to have received timely postnatal care. The researchers suggest that in such cases, mothers-in-law may consider fertility and childbirth as part of men's domain and therefore do not try to impose their own opinions about maternal health care. In addition, women whose mother-in-law viewed them as independent decision makers about their own health care were more likely to have received at least four antenatal visits.

A woman's own beliefs about her power to make independent decisions about her health care and her opinion about the quality of services at local health facilities were also factors linked to maternal health practices. Women who viewed themselves as able to make such decisions were almost twice as likely as other women to have delivered in a health care institution, and were more likely to have received timely postnatal care from a skilled provider. This concurs with previous findings that a woman who views herself as empowered to make her own decisions is more likely to adopt preventive health care behaviors.

The author noted that future research and programmatic efforts need to consider gender norms in particular societies and the influence of family members besides the woman and her husband, such as her mother-in-law, in making decisions about maternal health care. "The Influence of Interfamilial Power on Maternal Health Care in Mali: Perspectives of Women, Men and Mothers-in-Law," is available in the latest issue of International Perspectives on Sexual and Reproductive Health.