Pregnant women's decision-making capacity and adherence to iron supplementation in sub-Saharan Africa: a multi-country analysis of 25 countries.

BACKGROUND: Anaemia and related complications during pregnancy is a global problem but more prevalent in sub-Sahara Africa (SSA). Women's decision-making power has significantly been linked with maternal health service utilization but there is inadequate evidence about adherence to iron supplementation. This study therefore assessed the association between household decision-making power and iron supplementation adherence among pregnant married women in 25 sub-Saharan African countries. METHODS: We used data from the Demographic and Health Surveys (DHS) of 25 sub-Saharan African countries conducted between 2010 and 2019. Women's decision-making power was measured by three parameters; own health care, making large household purchases and visits to her family or relatives. The association between women's decision-making power and iron supplementation adherence was assessed using logistic regressions, adjusting for confounders. The results were presented as adjusted odds ratio (AOR) with 95% confidence intervals (CIs). RESULTS: Approximately 65.4% of pregnant married women had made decisions either alone or with husband in all three decisions making parameters (i.e., own health care, making large household purchases, visits to her family or relatives). The rate of adherence to iron medication during pregnancy was 51.7% (95% CI; 48.5-54.9%). Adherence to iron supplementation was found to be higher among pregnant married women who had decision-making power (AOR = 1.46, 95% CI; 1.16-1.83), secondary education (AOR = 1.45, 95% CI; 1.05-2.00) and antenatal care visit (AOR = 2.77, 95% CI; 2.19-3.51). Wealth quintiles and religion were significantly associated with adherence to iron supplementation. CONCLUSIONS: Adherence to iron supplementation is high among pregnant women in SSA. Decision making power, educational status and antenatal care visit were found to be significantly associated with adherence to these supplements. These findings highlight that there is a need to design interventions that enhance women's decision-making capacities, and empowering them through education to improve the coverage of antenatal iron supplementation.

The role of traditional contraceptive methods in family planning among women attending primary health care centers in Kano.

Background: Traditional contraceptive methods (TCMs) have been used by our ancestors for a long time in child spacing before the advent of the modern contraceptive methods but even with the introduction of the modern methods some women prefer and are still using TCMs. Aim: The aim of this study was to assess the utilization of traditional contraceptives in child spacing and its association with family size among women of child-bearing age attending primary healthcare centers in Kano. Materials and Methods: This was a cross-sectional study among 400 women attending primary healthcare centers in Kano. Their sociodemographic characteristics, number of children, knowledge, and use of traditional contraceptives were recorded on a pretested questionnaire. Results: The mean age ± standard deviation (SD) was 29.1 ± 6.22 years. The mean number of children (±SD) was 3.9 ± 2.27. A total number of 280 (70.0%) participants knew about TCMs, but only 147 (36.8%) used these methods and among those that used TCMs, herbal medicine was the most used method (n = 67, 45.6%). There was no statistically significant difference between the mean number of children of the respondents who used traditional contraceptives and those who did not (t = 0.382, df = 398, P = 0.703, 95% confidence interval:-0.374-0.555). Educational status was significantly associated with the use of traditional contraceptives (χ2 = 8.327, P = 0.005). Conclusion: There was more knowledge of traditional than modern contraceptive methods. Herbal medicine was the most commonly used method. There was poor utilization of the modern contraceptive methods and fair utilization of the TCMs. The study showed no clear benefit of traditional contraceptive usage over its nonuse in reducing family size.

RésuméContexte: Les méthodes contraceptives traditionnelles (MTC) ont longtemps été utilisées par nos ancêtres dans l'espacement des naissances avant l'avènement des méthodes contraceptives modernes, mais même avec l'introduction des méthodes modernes certaines femmes préfèrent et utilisent encore les MTC. But: Le but de cette étude est d'évaluer l'utilisation des contraceptifs traditionnels dans l'espacement des naissances et son association avec la taille de la famille parmi les femmes en âge de procréer fréquentant les centres de soins de santé primaires à Kano. Matériels et méthodes: Il s'agissait d'une étude transversale parmi 400 femmes fréquentant les centres de soins de santé primaires à Kano. Leurs caractéristiques sociodémographiques, le nombre d'enfants, la connaissance et l'utilisation de les contraceptifs traditionnels ont été enregistrés sur un questionnaire pré-testé. Résultats: L'âge moyen ± écart type (ET) était de 29,1 ± 6,22 ans. Le nombre moyen d'enfants (± écart-type) était de 3,9 ± 2,27. Un chiffre de 280 (70,0%) connaissait les MTC, mais seulement 147 (36,8%) utilisaient ces méthodes et parmi celles qui utilisaient des MTC, la phytothérapie était la méthode la plus utilisée (n = 67, 45,6%). Il n'y avait pas de différence statistiquement significative entre le nombre moyen d'enfants des répondants qui ont utilisé des contraceptifs traditionnels et ceux qui ne l'ont pas fait (t = 0,382, df = 398, P = 0,703, Intervalle de confiance de 95%: -0,374-0,555). Le statut éducatif était significativement associé à l'utilisation des contraceptifs traditionnels (χ2 = 8,327, P = 0,005). Conclusion: Il y avait plus de connaissance des méthodes contraceptives traditionnelles que modernes. La phytothérapie était la plus méthode couramment utilisée. Les méthodes modernes de contraception et l'utilisation équitable des MTC ont été mal utilisées. L'étude a montré pas de bénéfice clair de l'utilisation traditionnelle de la contraception par rapport à sa non-utilisation pour réduire la taille de la famille. Mots-clés: Planification familiale, rôle, méthodes contraceptives traditionnelles.

Responsiveness of the Golombok Rust Inventory of Sexual Satisfaction in couples with incontinent partners.

OBJECTIVE: In order for a measure to reliably evaluate treatment efficacy, it is important that the measure used has adequate responsiveness. However, the responsiveness of the Golombok Rust Inventory of Sexual Satisfaction (GRISS) questionnaire, a highly recommended questionnaire by the International Consultation of Incontinence to assess sexual function in patients with incontinence, has not been established. To enable the use of GRISS to measure change in sexual function following incontinence treatment, we evaluated the short- and long-term responsiveness of the GRISS in couples with female stress urinary incontinence partners. STUDY DESIGN: Forty-eight couples with female stress urinary incontinence partners were included in the study. The GRISS, a 28-item multidimensional measure, comprises two sets of questionnaires to assess sexual function in both male and female partners. Responsiveness was investigated using data from our recent randomized controlled trials evaluating efficacy of pulsed magnetic stimulation for treatment of female patients with stress urinary incontinence. Effect size index and standardized response mean were used to measure responsiveness of the English and Chinese versions of GRISS. RESULTS: For short-term responsiveness, the overall female and male GRISS scores had effect sizes and standardized response means ranging from 0.60 to 0.83 and 0.44 to 0.78 respectively. For long-term responsiveness, the overall female and male GRISS scores had effect sizes and standardized response means ranging from 0.59 to 0.77 and 0.48 to 0.79 respectively. CONCLUSION: In conclusion, the English and Chinese versions of GRISS had adequate responsiveness for use in couples with incontinent partners. The GRISS can be a useful measure to detect change in sexual function of couples following treatment of females with stress urinary incontinence.

Socioeconomic and Demographic Factors Influencing Feeding Practices, Morbidity Status, and Dietary Intakes of Children Aged 7-24 Months in Rural Uganda.

The objective of this study was to analyze the nutritional and morbidity patterns of children aged 7-24 months in relationship to household socioeconomic and demographic characteristics. Structured questionnaires and repeated 24-hour recalls were used to collect data. Maternal education and age influenced timing of complementary foods, dietary diversity score, meal frequency, and diarrhea incidences (p < .05). This resulted in 53%, 59%, 48%, 43%, and 22% of the study children having inadequate intake of energy, protein, vitamin A, iron, and zinc, respectively. Households need to be empowered to utilize available resources for improving nutrient intake and health among their children.

Nutrition education linked to agricultural interventions improved child dietary diversity in rural Cambodia.

Poor infant and young child feeding (IYCF) practices are major determinants of chronic malnutrition. The main objective of this study was to assess the impact of a nutrition education (NE) programme aimed at promoting improved IYCF behaviours in combination with an agriculture intervention on children's dietary diversity and nutritional status. From 2012 to 2014, a cluster randomised trial was rolled out in Cambodia in the context of an agriculture and nutrition project of the FAO of the UN. The cross-sectional baseline study was carried out in sixteen pre-selected communes in 2012. Restricted randomisation allotted the communes to either intervention (NE and agriculture intervention) or comparison arms (agriculture intervention only). The impact survey was conducted as a census in all FAO project villages in 2014. Caregivers of children aged 0-23 months were interviewed using standardised questions on socio-economic status and dietary diversity (24-h recall). Anthropometric measurements were taken. A difference-in-differences model was applied. The sample comprised 743 households with children ≥6 months of age at baseline and 921 at impact. After 1 year of NE, 69 % of the intervention households reported to have participated in the NE. Estimated mean child dietary diversity was significantly different at impact between comparison and intervention (3·6 and 3·9, respectively). In particular, the consumption of pro-vitamin A-rich foods and other fruits and vegetables increased. No treatment effects on height-for-age Z-scores could be shown. NE led to improvements in children's diets. For effects on growth, it is assumed that longer NE activities are required to achieve sustainable behaviour change of age-appropriate infant feeding.

Influence of Seasonal On-Farm Diversity on Dietary Diversity: A Case Study of Smallholder Farming Households in Western Kenya.

This study explored the associations between dietary patterns and farm diversity as well as socioeconomic variables during two seasons in rural Western Kenya. As a mean of two surveys, the average dietary diversity scores (DDS) of households and women were low, implying low household economic access to food and low women's dietary quality. The Food Consumption Score (FCS) showed that acceptable levels of food consumption were realized over seven consecutive days in the 2014 survey by the majority of households (83%) and women (90%). While there was no strong association between the food scores and seven farm diversity indicators, both food scores were significantly associated with the household's wealth status, ethnicity of both the household head and the spouse, and the education level of the spouse. For holistic household food and nutrition security approaches, we suggest a shift from a focus on farm production factors to incorporating easily overlooked socioeconomic factors such as household decision-making power and ethnicity.

Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda.

BACKGROUND: Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization's Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context. METHODS: This study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes. RESULTS: Contrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives' healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care. CONCLUSION: In this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities.

Consumption of highly processed snacks, sugar-sweetened beverages and child feeding practices in a rural area of Nicaragua.

Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar-sweetened beverages (SSBs). All households with at least one child 0- to 35-month-old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0- to 1-month-olds and continued to be prevalent (60%) in the second year, while only 34% of the 0- to 5-month-olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6- to 11-month-old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6- to 8-month-olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long-term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.

Usual coffee intake in Brazil: results from the National Dietary Survey 2008-9.

Coffee is central to the economy of many developing countries, as well as to the world economy. However, despite the widespread consumption of coffee, there are very few available data showing the usual intake of this beverage. Surveying usual coffee intake is a way of monitoring one aspect of a population's usual dietary intake. Thus, the present study aimed to characterise the usual daily coffee intake in the Brazilian population. We used data from the National Dietary Survey collected in 2008-9 from a probabilistic sample of 34,003 Brazilians aged 10 years and older. The National Cancer Institute method was applied to obtain the usual intake based on two nonconsecutive food diaries, and descriptive statistical analyses were performed by age and sex for Brazil and its regions. The estimated average usual daily coffee intake of the Brazilian population was 163 (SE 2.8) ml. The comparison by sex showed that males had a 12% greater usual coffee intake than females. In addition, the highest intake was recorded among older males. Among the five regions surveyed, the North-East had the highest usual coffee intake (175 ml). The most common method of brewing coffee was filtered/instant coffee (71%), and the main method of sweetening beverages was with sugar (87%). In Brazil, the mean usual coffee intake corresponds to 163 ml, or 1.5 cups/d. Differences in usual coffee intake according to sex and age differed among the five Brazilian regions.

Sociocultural influences on newborn health in the first 6 weeks of life: qualitative study in a fishing village in Karachi, Pakistan.

BACKGROUND: Given regional variability and minimal improvement in infant mortality rates in Pakistan, this study aimed to explicate sociocultural influences impacting mothers' efforts to maintain or improve newborn health. METHODS: We used a qualitative phenomenological approach. A total of 10 mothers and 8 fathers from a fishing village in Karachi, Pakistan were purposefully sampled and interviewed individually. A focus group was undertaken with four grandmothers (primary decision makers). Transcripts were independently reviewed using interpretive thematic analysis. RESULTS: A multigenerational approach was used in infant care, but mothers did not have a voice in decision-making. Parents connected breast milk to infant health, and crying was used as cue to initiate feeding. Participants perceived that newborns required early supplementation, given poor milk supply and to improve health. There were tensions between traditional (i.e., home) remedies and current medical practices. Equal importance was given to sons and daughters. CONCLUSION: Findings suggest that social and cultural influences within families and the community must be considered in developing interventions to improve newborn health. Introducing non-breast milk substances into newborn diets may reduce the duration of exclusive or partial breastfeeding and increase risks to infant health.

Food consumption patterns and associated factors among Vietnamese women of reproductive age.

BACKGROUND AND OBJECTIVES: Adequate nutrient intakes among women of reproductive age (WRA) are important determinants of maternal, neonatal and child health outcomes. However, data on dietary intake for WRA in Vietnam are lacking. This paper aimed to examine the adequacy and determinants of energy and macronutrient intakes among WRA enrolled in a study of preconceptual micronutrient supplementation (PRECONCEPT) being conducted in 20 rural communes in Thai Nguyen province, Vietnam. METHODS: Dietary intakes were determined for 4983 WRA who participated in the baseline survey using a previously validated 107-item (semi-quantitative) food-frequency questionnaire that was administered by trained field workers. Multivariate linear and logistic regression analyses were used to examine factors associated with energy and macronutrient intakes. RESULTS: A disproportionate number of energy came from starches, primarily rice. Carbohydrate, fat and protein constituted 65.6%, 19.5% and 14.8% of total energy, respectively. Fat intake was below recommended levels in 56.5% of respondents, but carbohydrate intakes were above recommended level in 54.6%. Only 0.1% and 5.2% of WRA achieved adequate intake of n-3 and n-6 long-chain polyunsaturated fatty acids, respectively. Multivariate linear regression revealed that low education, low socioeconomic status, and food insecurity were significant predictors of reduced total energy intake, reduced energy from protein and fat, and greater energy from carbohydrates. Logistic regression confirmed that inadequate macronutrient intake was more common among the poor, food insecure, and less educated. CONCLUSIONS: Imbalanced dietary intakes among underprivileged women reflect lack of dietary diversity. Nutrition programs should be linked with social development, poverty reduction, education programs and behavior change counseling in order to improve the nutritional status of WRA in Vietnam.

The family as the foundation of political rule in western philosophy: a comparative analysis of Aristotle's politics and Hegel's philosophy of right.

For both Aristotle and Hegel, the family is the foundation in which the universalized rule of law is validated according to the political structure of the 'Polis' or 'State' itself. This composite whole or structure of society (Ancient Polis/Modern State) is the political end of humanity for both philosophers, which in turn finds its primordial beginning in the family. For Aristotle, it is in the kingly rule of the household that the property-based distinction of citizenship is set for the rule of his ideal Polis. For Hegel, it is in the love affirmed through caring affection within the nuclear family that the dialectical framework for the freedom of civil society, and the rational unity of a congregational 'spirit' in the State, finds its foundation. For both thinkers, the family sets the base for a political theory that defines citizenship in a manner that transcends the particularities of kin bonds.

Giving birth: the voices of Ghanaian women.

Childbirth is significantly influenced by women's cultural perceptions, beliefs, expectations, fears, and cultural practices. Our purpose in conducting this focused ethnography was to determine the perceptions of Ghanaian childbearing women. Twenty-four mothers who received health care at the Salvation Army Clinic in Wiamoase, Ashanti, Ghana, participated in audiotaped interviews. Patterns of thought and behaviors were analyzed, describing the realities of the lives of Ghanaian childbearing women. Themes included centering on motherhood, accessing health care, using biomedicine, ethnomedicine, and spiritual cures; viewing childbirth as a dangerous passage; experiencing the pain of childbirth; and fearing the influence of witchcraft on birth outcomes. Culturally specific knowledge obtained in this study can be utilized by health care providers, health policymakers, and those designing health care interventions to improve the health and well-being of childbearing women in developing countries.

Prophecy, patriarchy, and violence in the early modern household: the revelations of Anne Wentworth.

In 1676 the apostate Baptist prophet Anne Wentworth (1629/30-1693?) published "A True Account of Anne Wentworths Being Cruelly, Unjustly, and Unchristianly Dealt with by Some of Those People called Anabaptists," the first in a series of pamphlets that would continue to the end of the decade. Orignially a member of a London Baptist church, Wentworth left the congregation and eventually her own home after her husband used physical force to stop her writing and prophesying. Yet Wentworth persisted in her "revelations." These prophecies increasingly focused on her response to those who were trying to stop her efforts, especially within her own household. This article examines Wentworth's writings as an effort by an early modern woman, using arguments of spiritual agency, to assert ideas about proper gender roles and household responsibilities to denounce her husband and rebut those who criticized and attempted to suppress her.

Food variety score is associated with dual burden of malnutrition in Orang Asli (Malaysian indigenous peoples) households: implications for health promotion.

This paper reports on the presence of dual burden households in Orang Asli (OA, indigenous people) communities and its associated factors. A total of 182 OA households in two districts in Selangor with the required criteria (182 non-pregnant women of child bearing age and 284 children aged 2-9 years old) participated in the study. Height and weight of both women and children were measured. Energy intake and food variety score (FVS) were determined using three 24-hour diet recalls. While 58% were underweight and 64% of the children were stunted, the prevalence of overweight and obesity in women were 31% and 20% respectively. The percentage of dual burden households (overweight mother/underweight child) was 25.8% while 14.8% households had normal weight mother/normal weight child. The mean food variety score (FVS) was similar for women (7.0+/-2.1) and children (6.9+/-1.9). Dual burden households were associated with women's employment status (OR: 3.18, 95% CI: 2.65-5.66), FVS of children (OR: 0.71, 95% CI: 0.51-0.95) and FVS of women (OR: 1.39, 95% CI: 1.02- 1.89). The FVS of children (OR: 0.49, 95% CI: 0.25-0.89) and women (OR: 1.92, 95% CI: 1.64-2.77) remained significant even when dual burden households were compared to only households with normal weight mother/normal weight child. In these OA communities, food variety may predict a healthier diet in children, but may increase the risk of overweight and obesity in adults. Efforts to address households with dual burden malnutrition should consider promotion of healthy diets and lifestyle for all members.

[Household behaviour regarding health and drug consumption in Cameroon]. / Comportement de recours aux soins et aux médicaments au Caméroun.

To begin a renewal of national health policy in Cameroon, a steering committee from the Cameroon Ministry of Health and its partners sought to analyze health demand through a national population survey and supply capacity through a national survey of retail drug stores. A survey of healthcare consumers was also conducted. The present publication describes the results of the population survey. It measured perceived, rather than objective (diagnosed), morbidity. The morbidity ratio, defined as the proportion of persons who reported having been ill during the reference period, two weeks before the survey, was measured at 23% and varied with demographic, social, and economic characteristics such as age, sex, poverty, the sex and educational level of the head of the household, and place of residence (urban or rural). We asked about six types of response to illness: modern consultation, traditional consultation, modern self-medication, traditional self-medication, expectant management, and prayer. The approaches of individual therapeutic itineraries fluctuated for each subject, depending first on financial capacity, second on geographic accessibility, and third on socio-cultural perception of the illness, which governed in particular choice of a modern or traditional approach. Thus, less than a quarter of all subjects initially chose consultation in a health care centre, which accounted for only 31% of all approaches, and 37% of the effective health responses (excluding treatment abstention). Half, however, chose it as a second step, and 40% as a third. Globally, 56% of those who reported illness did not seek a modern consultation during this illness, and 23% of those who took three separate steps for the same illness never sought a modern consultation. Half of all household health expenditures were for medication, and this proportion was highest in the poorest population. In 2002, the population spent 366 billion CFA Francs on health care: 170 billion for drugs, 75 billion for medical examinations, 53 billion for hospitalization, 30 billion for consultations; and 22 billion for transportation.

Interiors, intentions, and the "spirituality" of Islamic ritual practice.

The Arabic term niyya (intention) is prominent in texts of Islamic ritual law. Muslim jurists require niyya in the "heart" during such ritual duties as prayer, fasting, and pilgrimage. Western scholars often treat niyya as a "spiritual" component of Islamic ritual. Muslim jurists, however, consistently treat niyya as a formal, taxonomic matter, a mental focus that makes a given act into the specific named duty required by religious law. Although the effort to thrust niyya into a "spiritual" role is meant to defend Islam from charges of "empty ritualism," it subtly reinforces the characterization of Islam as rigidly legalistic. Much scholarship on niyya belies the scholars' own definition of "proper religion" centered on an inner, individual, nonmaterial dimension of the self. Instead of trying to wash away the formalism of niyya, I argue that scholars ought to recognize that such embodied practices are properly religious rather than spiritually defective.

Contextual influences on reproductive wellness in northern India.

OBJECTIVES: There has been a growing recognition of the importance of contextual influences on health outcomes. This article examines community-level influences on 5 reproductive wellness outcomes in Uttar Pradesh, India. METHODS: Multilevel modeling is used to estimate household and community-level effects on wellness, with hierarchically organized data from a statewide survey of villages, urban blocks, households, women, health providers, and staff. RESULTS: The household and community have a strong contextual influence on wellness, although the models explain more of the variation in outcomes between households than between communities. CONCLUSIONS: Communities influence wellness outcomes through the socioeconomic environment and the characteristics of the health infrastructure. The specific dimensions of the community and health infrastructure varied between the outcomes.

Networks of nomads: negotiating access to health resources among pastoralist women in Chad.

Health resources among pastoralist groups are strongly gendered. While certain types of health resources fall within the female domain (home-based treatment, caring and supportive roles, and knowledge surrounding particular reproductive conditions) access to most outside health practitioners, treatments and knowledge is controlled largely by men. For pastoralist women, this means that actions taken during illness episodes depend largely on the nature and quality of social support systems available, and on their ability to mobilise them effectively. These support systems include husband and other affines, male kin, and networks of female kin and friends. Factors such as position within domestic and wider social units, as well as life cycle, affect women's ability to access and mobilise these different support systems for their health needs. However, seasonal mobility interacts with gender and social support systems in complex ways that profoundly influence women's access to health resources. Most literature on nomadic peoples and health focuses on the physical barriers posed by spatial mobility to accessing health resources. However, it is suggested here that, for pastoralist women in Chad, the spatial fluidity of social networks might be a more important consideration. At certain times of the year women enjoy relatively easy access to a large range of extended kin and other social contacts, while at other times, when people are very dispersed, options become much more limited, often resulting in illness treatment being delayed. Mobility should not, though, be seen purely as a constraint. It can also be an opportunity, increasing the potential geographical and social resource base with regard to health for women.