Women's Land Rights and Maternal Healthcare in Southwestern Uganda: Exploring the Implications of Women's Decision-Making Regarding Sale and Use of Land on Access to Maternal Healthcare.

Most traditional land tenure practices among developing economies are opposed to protecting and promoting women's land ownership rights. In Uganda, land tenure practices are largely customary and patriarchal in nature, in most communities women's land tenure security is dependent on marriage. This paper builds a body of evidence on how gender biased land tenure negatively affects maternal healthcare decision-making for family planning, antenatal care services and skilled care during childbirth. A cross-sectional mixed methodology was used to collect household survey data. Qualitative data from individual and focus group interviews were analysed using thematic content analysis. Land was found to be an important household factor that shapes women's maternal healthcare decision-making, not only through land ownership, but also through land's role as a source of identity, gendered land use decision-making patterns, and the allocation of resources that accrue from work on land. Most of the land-owning households are headed by men. More women than men expressed insecurity of tenure, despite the household's land ownership status. Land use decision-making, including its sale was significantly associated with maternal healthcare decision- making. Feeling secure on land was significantly associated with maternal healthcare decisions for planned pregnancy and use of antenatal care. Land purchasing was found to significantly determine place and skill level of providers for childbirth. In conclusion, women involvement in land purchasing decisions demonstrates more control and agency in the number of children. Women's land insecurity undermines their prospects for positive maternal health behaviours.