Locating the Informal in the Formal

Abstract

This paper explores the influences that led to the development of the Free Health Care Initiative (fhci), which requires the provision of free health services for pregnant women, lactating mothers, and children under the age of five years. The paper will explore the impact of the policy on women actors as both recipients and informal providers of health care in post-war Sierra Leone. Since the end of the Sierra Leone civil war in 2002, there has been much focus on maternal and child health issues due to the staggeringly high maternal and child mortality rates, when compared to the rest of the world. Currently, international considerations exist such as the Convention for the Elimination of All Forms of Discrimination Against Women (cedaw) and the Millennium Development Goals (mdgs) to ensure nations are responsive to women’s health concerns. These often externally driven policies may not be based on internal motivation, and may have negative local consequences.Although the fhci has improved accessibility of clinical services provided by the government by eliminating user fees, a provision was made to eliminate the services of traditional birth attendants (tbas), who historically provided affordable birth services for women in rural regions of Sierra Leone. The new health policy thus criminalizes the actions of tbas, stripping them of the ability to practice their craft and earn a living. This paper examines the sometimes-contradictory results inherent when international laws and mandates get translated into local contexts and problematizes the uni-dimensional ways in which women’s empowerment is often promoted.