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Depuis les années 1970, des mouvements militants internationaux dénoncent une approche médico- et techno-centrée de la naissance. En réponse à cette « techno-bio-médicalisation », le concept d’« accouchement humanisé » a émergé dans les années 1990 en Amérique latine puis s’est globalisé. Cet article propose d’analyser l’échec d’un projet japonais d’accouchement humanisé dans une maternité au Bénin. Sur la base d’observations participantes et d’entretiens, nous montrons que la proposition des actrices et acteurs du développement japonais se heurte à une forte incorporation de la « science obstétricale » par les soignant·e·s, et plus particulièrement par les sages-femmes béninoises. Plus précisément, en interdisant la présence d’un·e accompagnant·e auprès de la femme qui accouche et en refusant que celle-ci adopte une position autre que la position gynécologique, les sages-femmes reproduisent le modèle obstétrical dominant au détriment du confort et du bien-être des femmes. Since the 1970s, international activist movements have denounced a medical and techno-centric approach to birth. In response to this “techno-bio-medicalization” of birth, the concept of humanized childbirth emerged in the 1990s in Latin America and then became global. This article proposes to analyse the failure of a Japanese project of humanized childbirth in a maternity hospital in Benin. On the basis of participant observations and interviews, we show that the proposal of Japanese development actors came up against a strong incorporation of obstetrical science by the health workers and more particularly by the Beninese midwives. More specifically, by forbidding the presence of an attendant near the woman giving birth and by refusing to accept a position other than the gynaecological one, the midwives reproduce the dominant model of biomedicalization of childbirth to the detriment of women's comfort and psychological and social well-being.

International audience; Over the past decade, women in Western countries have taken to various social media platforms to share their dissatisfactory experiences with hormonal contraception, which may be pills, patches, rings, injectables, implants or hormonal intrauterine devices (IUDs). These online testimonials have been denounced as spreading “hormonophobia”, i.e. an excessive fear of hormones based on irrational causes such as an overestimation of health risks associated with their use, that was already aroused by the recurring media controversies over hormonal contraception. In order to move toward a reproductive justice framework, we propose to study the arguments that women and men (as partners of female users) recently put forward against hormonal contraception to see whether they are related to hormonophobia. The aim of this article is to conduct a systematic review of the recent scientific literature in order to construct an evidence-based typology of reasons for rejecting hormonal contraception, in a continuum perspective from complaints to choosing not to use it, cited by women and men in Western countries in a recent time. The published literature was systematically searched using PubMed and the database from the French National Institute for Demographic Studies (Ined). A total of 42 articles were included for full-text analysis. Eight main categories emerged as reasons for rejecting hormonal contraception: problems related to physical side effects; altered mental health; negative impact on sexuality; concerns about future fertility; invocation of nature; concerns about menstruation; fears and anxiety; and the delegitimization of the side effects of hormonal contraceptives. Thus, arguments against hormonal contraception appeared complex and multifactorial. Future research should examine the provider-patient relationship, the gender bias of hormonal contraception and demands for naturalness in order to understand how birth control could better meet the needs and expectations of women and men in Western countries today.

Le concept de "violences gynécologiques et obstétricales" a émergé au début des années 2000 en Amérique latine dans les milieux militants et scientifiques. Il a été repris à partir des années 2010 dans les débats féministes et politiques français et européens. Les militantes féministes, notamment à travers les réseaux sociaux et les médias, ont joué un rôle important dans la construction de cette question de santé publique. Ce concept est aujourd'hui mobilisé dans l'espace public, politique et académique, en France et à l'international. Il recouvre des réalités et des pratiques médicales diverses et permet de rendre compte des expériences, à la fois objectives et subjectives, des femmes. Les travaux en sciences sociales qui mobilisent cette nouvelle approche conceptuelle sont de plus en plus nombreux. Ils portent cependant majoritairement sur l'accouchement, alors que le domaine de la gynécologie reste plus largement à explorer.

Caesarean section can prevent maternal and neonatal mortality and morbidity. However, it involves risks and high costs which can be a burden, especially in low and middle income countries. The international healthcare community considers the optimal caesarean rate to be between 10% and 15%. The aim of this study is to assess its magnitude and correlates among women of reproductive age in urban and rural areas in Vietnam. We analyzed microdata from the national Multiple Indicator Cluster Survey (MICS) conducted in 2013-2014 using representative sample of households at the national level as well as regarding the urban and the rural areas. A total of 1,378 women who delivered in institutional settings in the two years preceding the survey were included. Frequency and percentage distributions of the variables were performed. Bivariate and multivariate logistic regression analysis were undertaken to identify the factors associated with caesarean section. Odds ratios with 95% confidence interval were used to ascertain the direction and strength of the associations. The overall CS rate among the women who delivered in healthcare facilities in Vietnam is particularly high (29.2%) with regards to WHO standards. After controlling for significant characteristics, living in urban areas more than doubles the likelihood of undergoing a CS (OR = 2.31; 95% CI 1.79 to 2.98). Maternal age at delivery over 35 is a major positive correlate of CS. Beyond this common phenomenon, distinct lines of socioeconomic and demographic cleavage operate in urban versus rural areas. The differences regarding correlates of CS according to the place of residence suggest that specific measures should be taken in each setting to allow women to access childbirth services appropriate to their needs. Further research is needed on this topic.

Background Benin and Mali introduced user fee exemption policies focused on caesarean sections (C-sections) in 2005 and 2009, respectively. These policies had a positive impact on access to C-sections and facility based deliveries among all women, but the impact on socioeconomic inequality is still highly uncertain. The objective of this study was to observe whether there was an increase or a decrease in urban/rural and socioeconomic inequalities in access to C-sections and facility based deliveries after the free C-section policy was introduced. Methods We used data from three consecutive Demographic and Health Surveys (DHS): 2001, 2006 and 2011–2012 in Benin and 2001, 2006 and 2012–13 in Mali. We evaluated trends in inequality in terms of two outcomes: C-sections and facility based deliveries. Adjusted odds ratios were used to estimate whether the distributions of C-sections and facility based deliveries favoured the least advantaged categories (rural, non-educated and poorest women) or the most advantaged categories (urban, educated and richest women). Concentration curves were used to observe the degree of wealth-related inequality in access to C-sections and facility based deliveries. Results We analysed 47,302 childbirths (23,266 in Benin and 24,036 in Mali). In Benin, we found no significant difference in access to C-sections between urban and rural women or between educated and non-educated women. However, the richest women had greater access to C-sections than the poorest women. There was no significant change in these inequalities in terms of access to C-sections and facility based deliveries after introduction of the free C-section policy. In Mali, we found a reduction in education-related inequalities in access to C-sections after implementation of the policy (p-value = 0.043). Inequalities between urban and rural areas had already decreased prior to implementation of the policy, but wealth-related inequalities were still present. Conclusions Urban/rural and socioeconomic inequalities in C-section access did not change substantially after the countries implemented free C-section policies. User fee exemption is not enough. We recommend switching to mechanisms that combine both a universal approach and targeted action for vulnerable populations to address this issue and ensure equal health care access for all individuals.

IntroductionMali and Benin introduced a user fee exemption policy focused on caesarean sections in 2005 and 2009, respectively. The objective of this study is to assess the impact of this policy on service utilisation and neonatal outcomes. We focus specifically on whether the policy differentially impacts women by education level, zone of residence and wealth quintile of the household.MethodsWe use a difference-in-differences approach using two other western African countries with no fee exemption policies as the comparison group (Cameroon and Nigeria). Data were extracted from Demographic and Health Surveys over four periods between the early 1990s and the early 2000s. We assess the impact of the policy on three outcomes: caesarean delivery, facility-based delivery and neonatal mortality.ResultsWe analyse 99 800 childbirths. The free caesarean policy had a positive impact on caesarean section rates (adjusted OR=1.36 (95% CI 1.11 to 1.66; P≤0.01), particularly in non-educated women (adjusted OR=2.71; 95% CI 1.70 to 4.32; P≤0.001), those living in rural areas (adjusted OR=2.02; 95% CI 1.48 to 2.76; P≤0.001) and women in the middle-class wealth index (adjusted OR=3.88; 95% CI 1.77 to 4.72; P≤0.001). The policy contributes to the increase in the proportion of facility-based delivery (adjusted OR=1.68; 95% CI 1.48 to 1.89; P≤0.001) and may also contribute to the decrease of neonatal mortality (adjusted OR=0.70; 95% CI 0.58 to 0.85; P≤0.001).ConclusionThis study is the first to evaluate the impact of a user fee exemption policy focused on caesarean sections on maternal and child health outcomes with robust methods. It provides evidence that eliminating fees for caesareans benefits both women and neonates in sub-Saharan countries.

Background: the vulva has often raised debate in society and brought up multiple questions. Surrounded by taboos and preconceived ideas dating back several centuries, it is now the source of a growing phenomenon: nymphoplasty. In a society evolving towards the encouragement of difference and body acceptance, young people are subjected to two opposing standards that can influence their views of the female sex.Objectives: to study student’s representations, preconceptions and anatomical knowledge of the female sex, and to compare these preconceptions according to the sex of the students.Methods: the quantitative observational tranverse study, used an anonymous online questionnaire, LimeSurvey®, which was distributed to students from Île de France, aged 18 to 25.Results: we collected 139 responses, including 107 female and 32 male students, working in different faculties in Ile de France. We have found that the vagina is fundamental in the perception of the female sex. Almost half of the students (49.5%) consider that the subject of the female sex is still taboo, although for a majority of them (75%) it is in the process of liberalization. The study showed that the representations of the female sex were more positive among male students than among female students (p Conclusion: our study shows the influence of ancestral portrayals of the female sex to this day. It highlights the severity of womens perspective towards their own sex, which is out of step with that of men. It shows the impact of sexual violence on the reproductive health of young women and the importance for health professionals to diagnose it. Debate on the female sex is advancing, but has not yet put an end to certain preconceived ideas and certain taboos.; Contexte : la vulve a souvent posé débat dans la société et soulevé de multiples questions. Entourée de tabous et d’idées préconçues remontant à plusieurs siècles, elle est aujourd’hui à l’origine d’un phénomène en expansion : la nymphoplastie. Dans une société évoluant vers la promotion de la différence et de l’acceptation de son corps, les jeunes sont soumis à deux courants opposés pouvant influencer leurs visions du sexe féminin.Objectif : l’objectif de cette étude est d’étudier les représentations, les préconceptions et connaissances anatomiques, en lien avec ces représentations, qu’ont les étudiant.es du sexe féminin, et de comparer ces préconceptions selon le sexe des étudiant.es.Population et méthode : nous avons réalisé une étude quantitative observationnelle, à l’aide d’un questionnaire anonyme en ligne de type LimeSurvey®, diffusé auprès d’étudiant.es d’Île de France âgés de 18 à 25 ans.Résultats : nous avons recueilli 139 réponses, comprenant 107 étudiant.es de sexe féminin et 32 de sexe masculin, travaillant dans différentes facultés d’Île de France. Nous avons constaté que le vagin occupe une place centrale dans les représentations du sexe féminin. Près de la moitié des étudiant.es (49,5%) considère que le sujet du sexe féminin est encore tabou bien que pour une majorité d’entre eux (75%) il est en voie de libéralisation. L’étude a montré que les représentations du sexe féminin étaient plus positives chez les étudiant.es de sexe masculin que chez ceux de sexe féminin (pConclusion : notre étude montre l’influence qu’exercent encore aujourd’hui des représentations ancestrales du sexe féminin. Elle met en avant la sévérité du regard des femmes envers leur propre sexe en décalage avec celui porté par les hommes. Elle montre la place qu’occupent les violences sexuelles dans la santé génésique des jeunes femmes et l’importance pour les professionnels de santé de les diagnostiquer. Les discours sur le sexe féminin se libéralisent, mais n’ont pas encore mis fin à certaines idées préconçues et à certains tabous.

Introduction / ObjectiveSexuality can be impacted by a pregnancy. We explore the determinants of sexuality in post partum.Methods331 adult and french-speaking women pregnant of singleton, were interviewed in 2 Ile-de-France maternities at the end of pregnancy, then re-interviewed by phone 1 and 8 months after the childbirth (n=257 and n=191 respectively). The data were analyzed by Excel®, Stata®, using χ ² or Fischer tests.Results At 8 month, 93,7% of the women resumed sexual intercourses (SI). The determinants of the SI resumption are the marital life, the satisfaction of the current relation with the spouse, the level of study and the occupation of the spouse, the perineal tears, and the presence of the spouse during the childbirth. pleasure felt during the SI is associated to the perineal rehabilitation, felt benefits on sexuality, the sufficient participation of the spouse in the domestic tasks, the presence of the spouse during the childbirth. We could not show any association with the route of delivery or the episiotomy. 50,3% of the women felt pain during pain during SI and 82,5% did not get any councelling about sexuality during the post partum period.ConclusionThe determinants of sexuality in post partum are multiple. Reinforcing the councelling role of the health professionals about sexuality after childbirth would be useful. We also suggest exploring non-penetrative sexuality, as well as the influence of breast feeding.; Introduction / ObjectifsLa grossesse peut venir perturber la sexualité des femmes et des couples. Nous explorons les déterminants de la sexualité en post partum.Matériel et méthodes331 femmes francophones, majeures et enceintes de singleton ont été interrogées dans 2 maternités d’Île-de-France en fin de grossesse puis réinterrogées par téléphone 1 et 8 mois après l’accouchement (n=257 et n=191 respectivement). Les données ont été traitées par Excel®, Stata®, par tests de χ² ou de Fischer.Résultats À 8 mois, 93,7% des femmes ont repris les rapports sexuels (RS). Les déterminants de la reprise des RS sont la vie maritale, la satisfaction de la relation actuelle avec le conjoint, le niveau d’étude et la profession du conjoint, les déchirures périnéales, et la présence du conjoint à l’accouchement. Le plaisir ressenti pendant les RS est associé à la rééducation du périnée, ses bienfaits ressentis, la participation suffisante du conjoint aux tâches domestiques, la présence du conjoint à l’accouchement. Nous n’avons pas pu montrer de lien avec la voie d’accouchement ou l’épisiotomie. 50,3 % des femmes ont eu des douleurs à la reprise des RS et 82,5% n’ont pas eu de conseils sur la sexualité en post partum.ConclusionLes déterminants de la sexualité en post partum sont multiples. Renforcer le rôle des professionnels de santé en matière de conseils sur la sexualité après l’accouchement serait utile. Nous suggérons aussi d’explorer la sexualité non-pénétrative, ainsi que l’influence de l’allaitement.

Introduction / ObjectiveIn France the caesarean section rate doubled in twenty years and is stable since 2003 at about 21%. This review aims to understand the French distinctiveness, by exploring the following topics: the perception and the real experience of this way of delivery, and if there is a real a wife demand for the caesarean.Methods26 semi-leading qualitative interviews have been leaded in the Institut Mutualiste Montsouris in Paris. Among 7 patients close to delivery and 19 who had delivered by caesarean section were interviewed. They have been transcribed and analysed by themes.Results We can resume that caesarean is considered by women as the last issue. Woman esteem feel damaged as they were unable to deliver alone, without medical assistance. Furthermore cesarean may impact the relationship with their child due to the separation, even if it is fully appreciated that father can have special time with the baby. Some of them consider caesarean as a way to avoid pains, others perceive it more painful. Some of patients experience caesarean with serenity when it is prepared. They recognize to be ambivalent knowing the importance of the preparation but considering it stressful and they avoid details during the preparation. Regarding sexuality, it does not seem to influence the idea of women have about caesarian in France. Concerning the choice from women to have caesarian, it is marginal. And not assumed by couples if requested. The patient fears to be judged by the medical profession and finally having negatives consequences in their pregnancy monitoring. Patient’s confidence in medical profession is high and the majority follows doctor’s recommendations: even if it is well appreciated to be involved in the decision, Doctors have the competences to decide. Two elements seem to allow women to have a good caesarian experience: a supportive attitude from the medical profession during the surgery, and the involvement of the future dad.ConclusionIn France women prefer in majority a normal delivery than a caesarian. They trust medical profession. It means that the medical profession approach is an answer to the increase of the caesarian demand. To be experienced as a real delivery, and not only as a surgical procedure, it would be helpful that all the perinatal medical professionals think together about how to humanize this surgical procedure.; Introduction / ObjectifsEn France, le taux de césarienne a doublé en 20 ans et depuis 2003 il s’est stabilisé autour de 21%. L’objectif de cette étude est de comprendre cette spécificité française en explorant les thèmes suivants : la perception et le vécu de cette voie d’accouchement, ainsi que l’existence ou non d’une demande de césarienne de la part des femmes. Matériel et méthodes26 entretiens qualitatifs semi-directifs ont été menés à l’Institut Mutualiste Montsouris à Paris, auprès de 7 patientes en fin de grossesse et 19 patientes ayant accouché par césarienne. Ces entretiens ont été analysés par thématique après avoir été retranscrits. Résultats Il ressort des entretiens que la césarienne est majoritairement perçue par les femmes comme une solution de dernier recours. Elle peut entraver l’estime de la femme, qui se sent incapable de mettre au monde son enfant sans aide médicale. Elle impacte également la qualité de la relation entre la mère et son enfant, notamment à cause du temps de séparation, bien que cela soit compensé par le moment privilégié offert au père à ce moment-là. Certaines femmes voient la césarienne comme un moyen d’échapper aux douleurs de l’accouchement par voie basse, d’autres la perçoivent comme plus douloureuse. Certaines patientes vivent sereinement leur césarienne, notamment quand elles ont y été préparées en cours de préparation à l’accouchement. Elles reconnaissent être ambivalentes, à la fois conscientes de l’importance d’être préparées à cette éventualité mais considèrent ce thème comme anxiogène et ne souhaitent pas nécessairement plus de détails durant ces séances. Quant à la sexualité, il semble que ce facteur influence peu l’image que les femmes se font de la césarienne en France. Concernant la demande d’une césarienne à l’initiative des femmes, celle-ci est marginale. Quand elle existe, elle n’est pas assumée par les couples. La patiente craint d’être jugée par le corps médical et que le suivi de sa grossesse en pâtisse. Le niveau de confiance vis-à-vis du corps médical est tel que la majorité des patientes adhère à la recommandation du médecin qui selon elles, a la compétence nécessaire pour choisir la voie d’accouchement. Cependant, elles veulent être impliquées dans la décision, mais il s’agit là plus d’un élément de forme que de fond. Deux éléments clés semblent permettre à la femme de bien vivre la césarienne : l’attitude bienveillante de l’équipe médicale pendant l’intervention chirurgicale, ainsi que la présence du père. ConclusionEn France, les femmes préfèrent majoritairement accoucher par voie basse plutôt que par césarienne. Le corps médical bénéficie d’un véritable « capital confiance » de la part des patientes. L’attitude des soignants, en France, fait donc office de rempart face à une demande émergente de césarienne. Afin que les femmes puissent la vivre comme un accouchement et non pas uniquement comme un acte chirurgical, il serait judicieux que tous les acteurs de la périnatalité se réunissent pour réfléchir à humaniser davantage cet acte chirurgical.