1. Avoiding a 'big' baby : local perceptions and social responses toward childbirth-related complications in Menabe, Madagascar
- Author
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Elliot Rakotomanana, Dolorès Pourette, Carole Pierlovisi, Ranjatiana Randriantsara, Chiarella Mattern, Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Université Paris Descartes - Paris 5 (UPD5), Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), Muséum national d'Histoire naturelle (MNHN), Université d'Antananarivo, Unité d'Epidémiologie [Antananarivo, Madagascar] (IPM), Institut Pasteur de Madagascar, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), The study 'Reproductive health, therapeutic pathways, and healthcare uptake in the Morondava-Menabe region' was founded by Louvain Cooperation and the Pasteur Institute of Madagascar. The 'Study on sociocultural determinants of stunting' was founded by the United States Agency for International Development. We wish to express our gratitude to them., The authors would like to thank Amber Cripps, Astrid Knoblauch, Chris Gordon, Yandé Thiaw and the three reviewers of the paper., and We also thank the NGOs FAFED and FANOITRA. We would like to thank all those who participated in the studies, the fokontany presidents, healthcare professionals, reninjazas and traditional practitioners, and obviously all the women and men who shared their experience with us.
- Subjects
Adult ,Maternal mortality ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Health (social science) ,Pregnant women's care pathways ,Local knowledge ,[SHS.ANTHRO-BIO]Humanities and Social Sciences/Biological anthropology ,Mothers ,Social issues ,03 medical and health sciences ,0302 clinical medicine ,History and Philosophy of Science ,Health facility ,Nursing ,Pregnancy ,Health care ,medicine ,Madagascar ,Childbirth ,Humans ,030212 general & internal medicine ,Qualitative Research ,[SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health ,030219 obstetrics & reproductive medicine ,[SHS.SOCIO]Humanities and Social Sciences/Sociology ,business.industry ,Public health ,Focus Groups ,Delivery, Obstetric ,Focus group ,Pregnancy Complications ,Spouse ,Anthropological approach ,Childbirth-related complications ,Female ,Perception ,Traditional birth attendant ,Psychology ,business - Abstract
International audience; In Madagascar, a country where over 60% of deliveries are not attended by a healthcare professional, late or inadequate responses to complications during childbirth account for a great number of maternal deaths. In this article, we analyse local perceptions of birth-related risks and strategies used to avoid these risks or manage complications of childbirth. We conduct this analysis in light of the social meanings of childbirth and the social expectations placed upon women in a context of socioeconomic vulnerability and a challenged public health system. We conducted two separate studies in the district of Morondava (Menabe region) in June 2014 and March 2015, comprising semi-directive interviews with 111 people (59 mothers, 18 members of their immediate en-tourage and 34 institutional or healthcare stakeholders), and eight focus groups discussions-two with community leaders, and six with fathers. The results show that the social pressure exerted on women to give birth without complications leads them to practices aimed at avoiding a "big" baby including dietary restrictions, physical activity, and refusal of iron supplementation intake. During pregnancy, women are usually accompanied by a traditional birth attendant or matron (reninjaza). Further, they use the public health system by attending antenatal consultations. However, women are reluctant to deliver in a health facility, where the practices of health professionals are in discordance with the social realities of women and local beliefs around childbirth. If complications arise, they are explained by social causes. The parturient woman is only taken to a healthcare facility after carrying out rituals and if the problems do not resolve themselves. These findings support recommendations to reduce the cultural distance between health workers and childbearing women, strengthen the collaborations with reninjazas, and inform women and their decision makers (mother, reninjaza, spouse) about nutrition during pregnancy and signs of complications.
- Published
- 2018
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