Search

To achieve Millennium Development Goal 5 on maternal health, many countries have focused on marginalized women who lack access to care. Promoting facility-based deliveries to ensure skilled birth attendance and emergency obstetric care has become a main measure for preventing maternal deaths, so women who opt for home births are often considered 'marginal' and in need of targeted intervention. Drawing upon ethnographic data from Nicaragua, this paper critically examines the concept of marginality in the context of official efforts to increase institutional delivery amongst the rural poor, and discusses lack of access to health services among women living in peripheral areas as a process of marginalization. The promotion of facility birth as the new norm, in turn, generates a process of 're-marginalization', whereby public health officials morally disapprove of women who give birth at home, viewing them as non-compliers and a problem to the system. In rural Nicaragua, there is a discrepancy between the public health norm and women's own preferences and desires for home birth. These women live at the margins also in spatial and societal terms, and must relate to a health system they find incapable of providing good, appropriate care. Strong public pressure for institutional delivery makes them feel distressed and pressured. Paradoxically then, the aim of including marginal groups in maternal health programmes engenders resistance to facility birth. [ABSTRACT FROM AUTHOR]

Current international debates and policies on safe motherhood mainly propose biomedical interventions to reduce the risks during pregnancy and delivery. Yet, the conceptualisations of risk that underlie this framework may not correspond with local perceptions of reproductive dangers; consequently, hospital services may remain underutilised. Inspired by a growing body of anthropological literature exploring local fertility-related fears, and drawing on 15 months of fieldwork, this paper describes ideas about risky reproduction and practices of pregnancy protection in a Cameroonian village. It shows that social and supernatural threats to fertility are deemed more significant than the physical threats of fertility stressed at the (inter)national level. To protect their pregnancies from those social and supernatural influences, however, women take very physical measures. It is in this respect that biomedical interventions, physical in their very nature, do connect to local methods of pregnancy management. Furthermore, some pregnant women purposefully deploy hospital care in an attempt to reduce relational uncertainties. Explicit attention to the intersections of the social and the physical, and of the supernatural and the biomedical, furthers anthropological knowledge on fertility management and offers a starting point for more culturally sensitive safe motherhood interventions. [ABSTRACT FROM AUTHOR]

The anthropological part of the present research project addresses the issue of risk and uncertainties relating to perinatality and disability, and draws from the discourses of professionals in a perinatal network in the French Lorraine region. From an anthropological point of view, it is necessary to determine how and to what extent the views of professionals determine the network's management policies. The place conferred to 'the user' in these representations is one of several important issues to be analysed in order to gain better understanding of the management of relationships that result from it. What is the position of professionals who 'negotiate' and 'organise' the cost of the risk of disability when grasped in connection with their images of the 'users' (children and parents)? This qualitative study consisted of 40 semi-structured interviews conducted with 20 medical, social, and community professionals, all involved directly or indirectly with the network. The results demonstrate the importance of a network assessment as a 'culture' from the social and cultural relations of network professionals. These relations form the cement of a structure made of interpersonal ties and rooted in particular histories around a 'user' that are conveyed through individual narratives. [ABSTRACT FROM AUTHOR]