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See detailGouverner la maternité au Bénin. Les difficiles conditions d'application des politiques sanitaires dans le territoire de la Pendjari
Sambiéni, N'Koué Emmanuel ULg

Doctoral thesis (2012)

The Tanguieta health district, an important component of the Benin health care system, has been experiencing since the decentralization of the system autonomous management of modern health care at all ... [more ▼]

The Tanguieta health district, an important component of the Benin health care system, has been experiencing since the decentralization of the system autonomous management of modern health care at all levels. It is particularly ingenious in generating health care initiatives in favor of mothers engaged in childbirth, with the support of the State and its partners from the health sector. This commitment is officially justified by the critical situation of maternal health indicators, which are high mortality and morbidity rates. The Tanguieta health district is first a socio-cultural entity of remarkable uniqueness compared to other parts of the country, due to its geographical location, its pandjarian cultural identity and its sociopolitical history. On the basis of this very cultural and sociopolitical identity, the district claims its technical and administrative autonomy in the provision of health care. The intellectual curiosity of this socio-anthropological research was to understand how demand and health care for women who want “to give life” are structured and governed in this socio-cultural and medical area. “Maternal habitus” and “gouvernementality” have been at the same time concepts and methodological and epistemological aspects for decoding and analyzing “order” and “progress” in these logical and obstetrical practices. Essentially qualitative, the research was four years long during which I was mostly in the field observing in maternity hospitals and families, and interviewing various stakeholders involved in care. In this area, traditional institutions have been managing childbirth leaving a narrow space for parents to actively participate in the process of birth giving. Modern maternity hospitals are still struggling for the control of health care during and after childbirth. Unfortunately, traditional institutions are weakened by many social influences and therefore are unable to protect adequately childbirth. Consequently, traditional and modern maternity hospitals are still fatal and morbid. Having little knowledge of socio-cultural realities, the state and its maternal health care supervision institutions, are constantly depending on United States agencies and other private partners, providers of ideological and militant strategies. The National Strategy for the Reduction of Maternal and Neonatal Mortality and the Initiative Woman for Woman developed by the Health Ministry and the zonal management team of the Tanguieta health district underscore a missed rendezvous in the scheduled meeting between the users of maternity hospitals and treatment delivery in the planning of health care. All both elaborate plan. The maternity hospital, with its numerous actors in permanent negotiation without consensus, is conflict bound and often turned away from its mission. It is regularly inserting strategies while at the same time evicting its first beneficiaries and putting the health stakes in the background. For Safe Motherhood in traditional and modern spaces, we have to understand how women always engaged in such a morbid and fatal undertaking can strengthen their legitimate situation in the negotiation for obtaining essential and immediate obstetric health care among the cloud of institutions that control them. We have also to study how can traditional obstetric actors convince themselves of obstetric risks. [less ▲]

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