Abstract
BackgroundIn sub-Saharan Africa (SSA), nomads account for 30 to 60 million people. Their mobility, due to a constant search for pastures and water points, makes health services less accessible to them. Few nomadic women use assisted delivery, which increases the risk of maternal mortality. The reasons behind this limited use have been poorly documented. The objective of this study was to understand the sociocultural determinants of assisted childbirth by nomadic women.MethodsWe conducted a qualitative research in the health area of Gossi (Mali), mainly populated by nomads. Data were collected through a literature review, 26 semi-structured interviews, a non-participant observation, and a logbook. Nomadic women who gave birth in the past three months were included in the study, whether they used assisted delivery or not. A thematic content analysis was performed with QDA Miner software.ResultsThe study identified a complex combination of determinants resulting in the use or non-use of assisted childbirth by the nomads of Gossi. Several participants recognized the value of assisted delivery but gave birth at home. They identified sociocultural determinants related to their representations and bodily experiences; the risks and emotions (fear, stress, anxiety) associated with pregnancy; the onset of labor and delivery; and their weak autonomy in terms of movement, decision-making, and economic agency. Nomadic women are not free in their movements, and in order to seek care, they require the permission and support of a man (husband, brother, or father). Furthermore, the participants are housewives, and men control family resources and make decisions regarding all financial matters. Assisted delivery is often only considered when there are complications.ConclusionThis research has made it possible to understand the sociocultural determinants of the use of assisted childbirth among nomadic women, which should be taken into account when organizing health services for these populations.
Highlights
In sub-Saharan Africa (SSA), nomads account for 30 to 60 million people
“Personally, I would go to the health center only when I have no hope left, when people decide for me.” (Fatimata, 27) Some justify their preferences with a concern for adhering to a social standard or tradition that recommends giving birth at home: “For home deliveries, we found our parents doing so and we followed in their footsteps.” (Lalla, 20)
This study helped to identify and understand a set of sociocultural determinants whose interaction influences the use of assisted childbirth by Tamasheq nomadic women in the health area of the commune of Gossi, Mali
Summary
In sub-Saharan Africa (SSA), nomads account for 30 to 60 million people. Their mobility, due to a constant search for pastures and water points, makes health services less accessible to them. Few nomadic women use assisted delivery, which increases the risk of maternal mortality. The reasons behind this limited use have been poorly documented. The situation in Mali is not different from that of other SSAs. According to the latest Demographic Health Survey (DHS V), conducted in 2012, the MMR is 368 maternal deaths per 100,000 live births, while the WHO estimated it at 587 per 100,000 live births in 2015 [7]. According to the latest Demographic Health Survey (DHS V), conducted in 2012, the MMR is 368 maternal deaths per 100,000 live births, while the WHO estimated it at 587 per 100,000 live births in 2015 [7]
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