The Relevance of Feminist Issues: Race, Class, and Sexuality to Maternal Mortality in Ghana

Patriarchy and Violence Against Women

Patriarchy is defined as “a system ruled over by men, whose authority is enforced through social, political, economic, and religious institutions” [8]. Many feminists do not agree with the concepts of patriarchy but vary in their views, especially the radical feminist. Patriarchy is embodied in cultural values, norms, and attitudes that perceive men as powerful in societies which allow them to maltreat women and their female children with all forms of violence or abuse [9]. It is historic that, most societies in the world have been patriarchal with the worst seen in developing countries, including Ghana. The ascendancy of men within the social structures as heads of the family result in expropriating women and undervaluing their work as housewives. Women, therefore, have very few rights in such societies and are constantly subjected to abuses, including intimate partner violence, rape, female genital mutilation, incest, sexual harassments, more [9, 10].

The denial of women’s rights in their homes and the absence of other viable economic opportunities in the communities’ force them to remain in abusive relationships [11, 12]. This leaves them with physical, psychological, and financial consequences, but traditional patriarchal dogma recognizes male leadership as an expression of power and control which requires women to be submissive than to challenge their husbands. Some of these principles insulate and empower the superiority of men to undermine women’s capability to stop their husbands from any wrongdoing [11, 12].

Regardless of the vast contribution made by the second and third-waves feminist theorists on the domestic violence, many women today appear to suffer substantially from violence within the household; they are unwilling to report it for fear of breaking up their relationships and being ridiculed, due to the importance of marriage in some societies. For instance, the value placed on marriage in the Ghanaian culture allows women to accept domestic violence, and, therefore, fail to report incidents of violence for fear of divorce [13]. Moreover, women in some ethnic groups or tribes in Ghana are blamed for acts of abuse by their husbands or partners on the hypothesis that they might have done something to deserve it and this deters them from reporting such occurrences for their partners to be reprimanded and corrected [14]. The perpetuation of inhumane acts against women of all ages in Ghana has prevailed for a lengthy period and appears to be heightened in recent times. In some Ghanaian cultures, old women are seen by society as witches and often thrown out of their family homes or ostracized from their communities whereas, old men are considered wisemen and respected by community members. Media reports in Ghana have shown scenes where old women accused of witchcrafts have been stoned to death or ostracized to distant communities designated for witches without any good social amenities [15, 16, 17, 18]. That said, women who have contributed to the development of their country are alienated from their communities to face abject poverty and hardship, all because of false accusations, if they happen to survive the violence melted to them when pronounced evil. A more recent occurrence of this inexplicable was the gruesome murder of 90-year-old women in a broad day light by some angry youths, in the Savana region of Ghana, for being the brain behind the lack of development in her community, having been accused by a traditional priest [19].

The classification of power and control in patriarchal societies has dire consequences on maternal health care, more specifically in developing countries, where there are poor health care delivery systems. In accordance with the World Health Organization (WHO), intimate partner violence (IPV) during pregnancy results in fatal adverse health outcomes for both the pregnant woman and her fetus. The physical damage to victim’s body and the later physiological effects of stress from current and earlier abuse also affect the development of the baby [20, 21]. A clinical study in Africa on IPV against pregnant women reported a prevalence rate of 23-40%, 3-27%, and 25-49%, respectively for physical, sexual and emotional IPV during pregnancy in Africa [22].

In Ghana, the highly patriarchal systems have deprived women of their entitlement, and, therefore, lack economic power to meet their basic needs, including good nutrition and health care during pregnancy and childbirth. This prevents a substantial number of women from accessing maternal health services even when the services are free, due to lack of money to pay for transportation and other indirect cost. This results in pregnancy-related complications which eventually could result in maternal deaths. It is, therefore, not surprising that Pool, et al. [21] found that violence during pregnancy was associated with perinatal and neonatal mortality in Ghana, with many having life-threatening abortions, and others opting for unsafe abortion in the early stages of their pregnancies to avoid giving birth to children with congenital defects.

Gender and Women’s Health

Western elite feminists consider gender as a distinct from sex arguing that sex is biological, and gender is socially constructed such that sex and gender identities are closely intertwined. That is, gender is not dependent on biology and sex is rooted in genetics and physiology while gender is a process acquired through acculturation [8]. Gender seems to be more complex and nuanced today than it used to be a decade ago, and the social interpretation of gender emerged when society understood the bodily differences in relation to biology [23]. Gender also regulates the differences and types of health problems that affect men and women which have the power to effect changes in health practices and priorities amongst countries worldwide [24].

The physiological differences between men and women could form the basis for the differences in health inequalities among both sexes. This, however, has resulted in the medicalization of normal processes in women. Women’s bodies have been considered as a host of disease by medical experts who intervene without adequate risk assessments. This has resulted in increased rates of Caesarian sections, hormonal treatment of symptoms of menopause, and increased dependence on formula feeding instead of breast feeding. These practices have been shown to have serious consequences for women’s health and their infants [1].

The use of men’s body measurements as standard units for medical practices is another form of gender bias against women since women’s body is physiologically different from men. The biological functioning of females with respect to childbearing predisposes some women to various health conditions including postpartum depression, a psychosocial condition which is misconstrued by some medical experts as psychiatric ailment. Women diagnosed with this condition after birth are put on antipsychotic therapy which could affect their personalities in the long run. The failure of health professionals to recognize the social and biological differences between women’s body and men, and consider them in decisions on medical diagnosis and prognosis could deepen the existing gender bias. Women are, therefore, seen as vulnerable in all walks of life, but policy makers around the world have failed to offer conditions necessary to improve women’s life to reduce the health inequities suffered per their social and biological roles, specifically in the developing world. In spite of their vulnerability, women appear to be more committed to the upbringing of children, especially in rural Ghana. Women living in the hard-to- reach areas in Ghana seem to work tirelessly to support their children at the formative stages of life with very strong attachment. In my practice as health practitioner for almost two decades, I can attest to the fact that women are seen more in hospitals, health centers, and clinics any time their wards are sick compared to men. Often times the majority of men are seen in the last days or in the unlikely events that their sick relatives are pronounced dead. The lengthy stay in hospitals and health centers where there are no rest rooms for mothers as well as the heightened anxieties also appears to predispose them to other health-related issues.

Feminism and Women’s Empowerment

Feminism is a broad term that covers a variety of feminist writing which argues in favor of women with respect to gender equality and empowerment. Anderson defined feminism as the societal view of men and women which do not show any biological or natural factor, and thus signifies a link between the daily struggle within a global context [25]. It is also a social/political ideology that seeks to defend the rights of women in all walks of life. Feminism started as a movement to reduce the negative impacts of political systems on women development described as the first, second, and third wave feminist movements. The first wave focused on the right of woman to vote and work shorter hours; the second considered women’s emancipation as a goal. The third wave critiqued the lack of inclusion of multiple oppressions faced by women, and focused on social change and intersectionality. These three waves of feminist movement, built on each other’s ideology to find equality and recognition for women at the local, national and international platforms which first started in developed countries.

The central theme of the book assigned is on the various feminist theories and movements directed towards social change to reclaim the distribution of power among men and women in society. The first four chapters of the book outline clearly women’s struggle since the mid-19th century when the feminist movements started, and the successes made in bridging the equity gap between men and women. Although much has been achieved through the many interactions of feminist scholars and other human rights activists within the United Nations, with emphasis on education of girls and women equitable employment, entry of women in politics, property and marriage rights, much more is needed in the developing world.

The representation of women in politics and leadership positions in Ghana is very low [26, 27]. Men outnumber women in parliamentary seats and other political appointments compared to other developing countries and the developed world. For instance, out of 230 members of parliaments in Ghana, only 37 are women, representing 16% which is far below the United Nations recommendation of 30% [28]. This could be explained by the lack of resources for women to compete with men for such positions as well as the lack of autonomy on the part of women to make such decisions without the support of their partners. Societal norms also play a major role in deciding who gets the nod as a political leader. Typically, men are more likely to emerge as political heads compared to females in Ghana, even though policy makers have taken cognizant of socio-economic consequences of gender equality.

The role of women in the home as mothers, doing domestic jobs without receiving wages from their husbands contributes to the lack of autonomy on their part to participate in politics. Childbearing on its own could be more than a full-time job depending on how many children one cares for within a household. Women in this situation lack autonomy to make decisions regarding their reproductive life, to improve their wellbeing due to the absence of financial power. The inability of governments and Civil Society Organizations to provide women with basic needs such as free basic education and good health care delivery system clearly informs us that women are still far behind regarding matters of equality and empowerment.