Gender norms play a critical role in influencing health-seeking behaviour, yet their influence on caregivers'

decision-making for children under five remains underexplored in Tanzania. This study examined how culturally

constructed gender roles affect caregivers' ability to recognise illness, make healthcare decisions, and access

timely treatment in Morogoro Municipality. A qualitative research design was employed, combining semi-

structured interviews, focus group discussions, and non-participant observations with 12 caregivers. Thematic

analysis revealed three main findings: (i) women are the primary caregivers responsible for identifying and

community education, male engagement in child health responsibilities, and women's economic empowerment.

By enlightening the intersection of gender norms and child health, this research contributes to advancing SDGs

3 (good health and well-being) and 5 (gender equality) in low-resource contexts.

Globally, prompt and appropriate care-seeking for common childhood illnesses remains a cornerstone of efforts

to reduce under-five morbidity and mortality. Infectious diseases such as pneumonia, diarrhoea, and malaria,

together with neonatal causes and malnutrition, continue to be leading contributors to child deaths in low- and

middle-income countries (World Health Organisation [WHO], 2024). Improving caregivers' recognition of

illness and promoting timely utilisation of health services are therefore essential strategies for enhancing child

readiness (Mburu et al., 2021). These determinants interact dynamically—for instance, perceived illness severity

may prompt care-seeking only when transport and finances are available, while social networks or community

health workers may mediate access to formal care (Feldhaus et al., 2015).

A growing body of research emphasises the central role of gender norms in shaping health-related behaviours

and access to care. Gender norms—socially shared expectations about appropriate roles, responsibilities, and

behaviours for men and women—influence who makes health decisions, who controls household resources, and

what forms of care are considered acceptable (Barasa et al., 2022). In maternal, newborn, and child health

contexts, men's involvement (or lack thereof), women's autonomy, and gendered expectations about caregiving

responsibilities have all been shown to affect timely utilisation of services (Greenspan et al., 2019). Studies from

Tanzania in particular highlight gendered decision-making patterns and male gatekeeping as important drivers

overlook local gender relations risk failing to reach children in need or may inadvertently reinforce inequitable

care patterns (Barasa et al., 2022).

This paper examines the gendered dimensions of health-seeking behaviour among caregivers of children under

five in Morogoro Municipality, Tanzania. Specifically, it analyses caregivers' reported care-seeking actions

alongside qualitative insights about household decision-making and normative expectations. The study aims to

(a) identify which gender norms most strongly influence decisions about seeking care for sick children, (b)

document how these norms interact with other barriers such as economic or service-related constraints, and (c)

suggest implications for gender-sensitive programming to improve timely and appropriate care for young

children. Addressing these aims contributes to both the local evidence base for Morogoro and the broader

literature on gender and child health in sub-Saharan Africa (Colvin et al., 2013; Greenspan et al., 2019; Barasa

drawing implications for policy, practice, and further gender-sensitive interventions.

This study was guided by the Gender and Development (GAD) theory, which provides a comprehensive

framework for understanding how socially constructed gender relations influence individual behaviour and

access to social services, including healthcare. The GAD perspective emerged in the 1980s as a response to the

limitations of the earlier Women in Development (WID) approach, which focused narrowly on women's

inclusion in development projects without addressing the underlying structural inequalities between men and

women (Rathgeber, 1990). Unlike WID, the GAD approach emphasises the social construction of gender roles,

power relations, and institutional dynamics that determine how men and women participate in, contribute to, and

benefit from development processes (Moser, 1993).

level but must be analysed within the broader context of gendered social relations (Moser, 1993; Parpart, 1993).

In this study, the GAD theory provided the conceptual lens for examining how gender norms and power relations

within households affect caregivers' decisions to seek healthcare for children under five in Morogoro

Municipality. Specifically, the theory guided the analysis of how men's authority in household decision-making

and women's caregiving roles influence the timeliness and choice of healthcare services. For example, women's

limited autonomy in financial decisions or the need to obtain permission from husbands before seeking care can

delay treatment for sick children, while male perceptions of caregiving as a female responsibility may reduce

paternal involvement in child health (Greenspan et al., 2019). Moreover, the GAD perspective drew attention to

the institutional and structural factors that reinforce gender inequalities in healthcare access, including cultural

norms, health system practices, and socioeconomic barriers. This theoretical orientation helped interpret how

gender norms are reproduced through both household-level interactions and broader community structures. The

the interpretation of findings by highlighting how gendered power dynamics and social expectations shape

caregivers' health-seeking practices in the study area.

engage men, community leaders, and institutions in transforming harmful gender norms that limit timely and

appropriate health-seeking for children under five.

This study employed a qualitative research approach to gain an in-depth understanding of caregivers' knowledge,

perceptions, and cultural influences influencing health-seeking behaviours for children under five. Qualitative

inquiry allows flexibility in probing participants' responses, thereby uncovering nuanced realities and hidden

meanings (Lim, 2025; Flick, 2018). Through this approach, the researcher was able to explore how gender norms

influence decision-making processes related to child health.

A cross-sectional research design was adopted to examine cultural influences on caregivers' health-seeking

behaviours at a specific point in time. This design facilitated the identification of patterns and associations among

key variables, including traditions, norms, and beliefs (Bryman, 2016). It also enabled data collection from a

participants based on their caregiving experience and familiarity with cultural health beliefs. Subsequently,

snowball sampling was used to expand participation through referrals (Naderifar et al., 2017), ensuring trust,

accessibility, and diversity in viewpoints. Data collection continued until theoretical saturation was achieved

after 12 interviews (Rahimi & Khatooni, 2024).

To ensure methodological triangulation and enhance validity, data were collected through interviews, focus

group discussions (FGDs), and non-participant observation (Denzin & Lincoln, 2011; Patton, 2015). Semi-

structured interviews were conducted with caregivers and key informants, including health workers, traditional

healers, religious leaders, and community elders. FGDs comprising four caregivers each were used to explore

collective beliefs and practices, while observations captured contextual behaviours and social interactions

influencing health decisions.

Thematic analysis guided data interpretation (Braun & Clarke, 2006). Transcripts were coded and categorized

Morogoro Municipality. The findings reveal that cultural expectations and socially constructed gender roles

strongly influence who provides care, who makes health-related decisions, and how resources are controlled and

allocated within households (Bedford & Sharkey, 2014; Wambui et al., 2018). In line with earlier studies in

African contexts (Bakare et al., 2020; Muraya et al., 2021), women were found to occupy the central caregiving

role but with limited decision-making power, while men were positioned as financial providers and ultimate

decision-makers. These gendered divisions of roles often determined whether and when children received

medical attention.

The results are presented under three major themes: (1) Women as primary caregivers with limited autonomy,

(2) Male authority and control over healthcare decisions, and (3) Negotiation, resistance, and consequences for

child health.

A male respondent illustrated this dynamic:

This reflects the entrenched division of labour where caregiving is feminised, while financial provision and

decision-making authority remain masculinised. Such norms reinforce male gatekeeping over access to formal

care, which often results in treatment delays. As Wambui et al. (2018) argue, women's restricted autonomy in

patriarchal households is a major barrier to timely health-seeking, with direct implications for child health

outcomes.

by Wambui et al. (2018), who noted that women's restricted autonomy contributes to poor child health outcomes

reported in other African contexts, where patriarchal norms reinforce male control over healthcare decisions,

thereby increasing children's vulnerability to preventable diseases (Bakare et al., 2020; Wambui et al., 2018;

Ngere et al., 2025a,b).

relatively small sample size and the reliance on self-reported data may have introduced potential biases such as

recall inaccuracies or social desirability tendencies, where participants might have provided responses perceived

as socially acceptable rather than their genuine experiences.

This study examined how gender norms shape caregivers' health-seeking behaviour for children under five in

Morogoro Municipality. The findings revealed that while mothers are primarily responsible for identifying and

managing childhood illnesses, their ability to act on these observations is often constrained by male authority