Gender Relations and Household Decision-Making in Women's Utilization of Prenatal Care Services in Kahama District, Tanzania

Prenatal care is important for identifying pregnancy-related risks, providing preventive interventions, and preparing women for childbirth. Nevertheless, timely use of prenatal care is influenced not only by service availability and individual knowledge but also by household relationships and the distribution of decision-making power. This article examines how gender relations and household decision-making influence women’s utilization of prenatal care services in Busoka and Nyasubi villages, Kahama District, Tanzania. Data were collected from 27 purposively selected participants, comprising 18 women of reproductive age and nine health-care and community actors, through interviews and focus group discussions, and were analysed thematically. Findings indicate that husbands and other household members could enable attendance by providing money, transport, encouragement, or accompaniment. However, dependence on partners for resources and permission could also delay or prevent attendance. Participants described restrictions related to domestic responsibilities, partner reluctance to participate in clinic procedures, and the influence of relatives and mothers-in-law on decisions about when to attend. The findings show that male involvement is not automatically supportive: its effect depends on whether it strengthens women’s agency or becomes a form of gatekeeping. The article argues that improving prenatal-care utilization requires gender-responsive interventions that promote shared responsibility while protecting women’s independent access to services.