Fluid Cash and Discordant Households: Exploring perceptions of and attitudes towards saving for childbirth : A qualitative study in Pallisa district, Uganda

Abstract: Background and Aim:  Maternal mortality in Uganda is among the highest in the world despite improvements in access to skilled delivery and emergency obstetric services. This is impacted in part by financial barriers.  This qualitative study explores men and women’s perceptions of and attitudes towards saving for childbirth and the related decision-making processes in rural eastern Uganda. Methods: Data was collected through six focus group discussions with community members, seven key informant interviews with members of the District Health Office and Commercial Office and observations. Data was analysed using thematic analysis. Results:  Men and women utilise savings to cope with varying demands, often taking precedence over preparing for childbirth.  A gender division in preferences and ability to save, underlined by poverty and illiteracy was identified.  Partners operated in separate financial spheres, with ambiguous financial responsibilities. Responsibility for childbirth was negotiated through household decision-making, but ultimately male partners held control over resources. Open communication and understanding between partners was perceived as key to saving for childbirth.   Male involvement was desired but complex and its best form undefined. Conclusion: Savings groups can act as a conduit for financial birth preparedness, but without increased co-operation within the household and an increased awareness of birth being a joint responsibility, money may be diverted to other priorities. Existing power structures must be recognised if male involvement is to be increased. A greater emphasis needs to be placed on improving communication between partners.