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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Sociocultural determinants of nomadic women’s utilization of assisted childbirth in Gossi, Mali: a qualitative study

Authors: M.A. Ag Ahmed, L. Hamelin-Brabant, M.P. Gagnon

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

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 objective of this study was to understand the sociocultural determinants of assisted childbirth by nomadic women.

Methods

We 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.

Results

The 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.

Conclusion

This 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.
Literature
1.
Lawn JE, Cousens S, Darmstadt GL, Paul V, Martines J. Why are 4 million newborn babies dying every year? Lancet. 2004;364:2020.CrossRef
2.
Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? where? why? Lancet. 2005;365:891–900.CrossRef
3.
WHO, UNICEF, UNFPA, The World Bank, The United Nations Population Division. Trends in Maternal Mortality: 1990 to 2015. Geneva: WHO; 2015.
4.
5.
6.
WHO U. UNFPA and The World Bank. Trends in Maternal Mortality: 1990 To 2008. In: Estimates developed by WHO, UNICEF. UNFPA and the World Bank. Geneva: WHO; 2010.
7.
OMS. Tendances de la mortalité maternelle: 1991-2015: estimations de l'OMS, l'UNICEF, l'UNFPA. In: le Groupe de la Banque mondiale et la Division de la population des Nations Unies: résumé d'orientation; 2015.
8.
Ronsmans C, Graham WJ. Maternal mortality: who, when, where, and why. Lancet. 2006;368(9542):1189–200.CrossRef
9.
Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ. 2007;85(10):812–9.CrossRef
10.
11.
Maine D. Programme pour la maternité sans danger: options et problèmes. Nueva York: Center for Population and Family Health Faculty of Medicine Columbia University; 1992.
12.
Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374:881–92.CrossRef
13.
14.
Prual A. La réduction de la mortalité maternelle dans les pays en voie de développement: théorie et pratique. Med Trop. 2004;64(6):569.
15.
Say L, Chou D, Gemmill A, Tuncalp O, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6):323–33.CrossRef
16.
Prual A, Bouvier-Colle M-H, Bernis L, Breart G. Severe maternal morbidity from direct obstetric causes in West Africa: incidence and case fatality rates. Bull World Health Organ. 2000;78(5):593–602.PubMedPubMedCentral
17.
Bang AT, Bang RA, Baitule SB, Reddy MH, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet. 1999;354(9194):1955–61.CrossRef
18.
Baqui A, Williams EK, Rosecrans AM, Agrawal PK, Ahmed S, Darmstadt GL, et al. Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India. Bull World Health Organ 2008;86(10):796-804A.CrossRef
19.
Graham WJ, Bell JS, Bullough CH. Can skilled attendance at delivery reduce maternal mortality in developing countries? Safe motherhood strategies: a review of the evidence. Brussels, Belgium: Paper presented at: European Commission expert meeting on safer motherhood; 2000. p. 27–8.
20.
21.
OMS. Rapport sur la santé dans le monde, 2005-donnons sa chance à chaque mère et à chaque enfant. Genève: OMS; 2005. p. 21–2.
22.
Campbell OM, Graham WJ. And lancet maternal survival series steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368(9543):1284–99.CrossRef
23.
24.
25.
Montavon A, Jean-Richard V, Bechir M, Daugla D, Abdoulaye M, Naré B, et al. Health of mobile pastoralists in the Sahel–assessment of 15 years of research and development. Tropical Med Int Health. 2013;18(9):1044–52.CrossRef
26.
Randall S. Visibilité et invisibilité statistique en Afrique. Adapter les méthodes de collecte de données aux populations ciblées. Afrique contemporaine. 2016;258(2):41–57.CrossRef
27.
Wiese M. La vulnérabilité des éleveurs nomades face aux problèmes de santé humaine au Tchad. Réflexions pour une meilleure prise en charge de la santé en milieu nomades au Tchad; 2000. p. 14–29.
28.
OMS. Résultats de l’Enquête rapide sur la disponibilité de services de santé au Mali avec l’outil HeRAMS de l’OMS. 2016.
29.
30.
Kruger C, Olsen OE, Mighay E, Ali M. Where do women give birth in rural Tanzania? Rural Remote Health. 2011;11(3):1791.PubMed
31.
32.
Wyss K, Bechir M, Schelling E, Daugla D, Zinsstag J. Quels types de services de sante pour les populations nomades? Apprentissages des activites de recherche et d’action au Tchad. Revue de Médecine Tropicale. 2004;64:493–6.
33.
Ould Taleb M. Santé, vulnérabilité‚ et tuberculose en milieu nomade Sahélien: Contribution à l'étude des représentations sociales de la tuberculose chez les populations nomades de la Mauritanie et du Tchad: Dissertation, University of Cocody, Abidjan, Côte d'Ivoire; 2008.
34.
Wiese M, Donnat M, Wyss K. Utilisation d’un centre de santé par des pasteurs nomades arabes–une étude de cas au Kanem, Tchad. Médecine tropicale. 2004;64:486–92.PubMed
35.
Ag EM. La grossesse et le suivi de l'accouchement chez les Touaregs Kel-Adagh (Kidal, Mali). Paris: Harmattan; 2010. p. 400.
36.
Hampshire K. Networks of nomads: negotiating access to health resources among pastoralist women in Chad. Soc Sci Med. 2002;54(7):1025–37.CrossRef
37.
Wako WG, Kassa DH. Institutional delivery service utilization and associated factors among women of reproductive age in the mobile pastoral community of the Liban District in Guji Zone, Oromia, Southern Ethiopia: a cross sectional study. BMC Pregnancy Childbirth. 2017;17(1):144.CrossRef
38.
Jackson R, Tesfay FH, Gebrehiwot TG, Godefay H. Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia. Tropical Med Int Health. 2017;22(2):148–60.CrossRef
39.
King R, Jackson R, Dietsch E, Hailemariam A. Utilisation of maternal health services in Ethiopia: a key informant research project. Dev Pract. 2016;26(2):158–69.CrossRef
40.
Zepro NB, Ahmed AT. Determinants of institutional delivery service utilization among pastorals of Liben Zone, Somali Regional State, Ethiopia, 2015. Int J Women's Health. 2016;8:705.CrossRef
41.
Caulfield T, Onyo P, Byrne A, Nduba J, Nyagero J, Morgan A, et al. Factors influencing place of delivery for pastoralist women in Kenya: a qualitative study. BMC Womens Health. 2016;16(1):52.CrossRef
42.
El Shiekh B, van der Kwaak A. Factors influencing the utilization of maternal health care services by nomads in Sudan. Pastoralism. 2015;5(1):23.CrossRef
43.
Gabrysch S, Campbell OM. Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth. 2009;9(1):34.CrossRef
44.
Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.CrossRef
45.
Lee AC, Lawn JE, Cousens S, Kumar V, Osrin D, Bhutta ZA, et al. Linking families and facilities for care at birth: what works to avert intrapartum-related deaths? Int J Gynecol Obstet. 2009;107:S65–88.CrossRef
46.
CSA. Plan de securité alimentaire de la commune rurale de Gossi 2006-2010. 2006.
47.
Wateraid. Plan sectoriel de developpement de la commune de Gossi dans la région de Tombouctou. 2007.
48.
Savoie-Zajc L. Comment peut-on construire un échantillonnage scientifiquement valide. Recherches qualitatives. Hors série. 2007;5:99–111.
49.
Pires A. De quelques enjeux épistémologiques d’une méthodologie générale pour les sciences sociales. In: La recherche qualitative Enjeux épistémologiques et méthodologiques Montréal: Gaëtan Morin Éditeur; 1997. p. 3–54.
50.
Ouellet F, Mayer R. Méthodologie de recherche pour les intervenants sociaux: Boucherville. Québec: G. Morin; 1991.
51.
Martineau S. L’observation en situation: enjeux, possibilités et limites. Recherches qualitatives. 2005;2:5–17.
52.
Gauthier B. Recherche sociale: de la problématique à la collecte des données: Puq; 2003.
53.
Paillé P, Mucchielli A. L'analyse qualitative en sciences humaines et sociales. 3e éd ed. Paris: A. Colin; 2012. p. 423.CrossRef
54.
Pope C, Mays N. Qualitative research in health care. 3rd ed ed. Malden, Mass: Blackwell Pub; 2006. p. 156.CrossRef
55.
Okafor I, Sekoni A, Ezeiru S, Ugboaja J, Inem V. Orthodox versus unorthodox care: a qualitative study on where rural women seek healthcare during pregnancy and childbirth in Southwest, Nigeria. Malawi Med J. 2014;26(2):45–9.PubMedPubMedCentral
56.
Babalola S, Fatusi A. Determinants of use of maternal health services in Nigeria-looking beyond individual and household factors. BMC Pregnancy Childbirth. 2009;9(1):43.CrossRef
57.
Brieger WR, Luchok KJ, Eng E, Earp JA. Use of maternity services by pregnant women in a small Nigerian community. Health Care Women Int. 1994;15(2):101–10.CrossRef
58.
Iyoke C, Ifeadike C, Nnebue C, Onah H, Ezugwu F. Perception and care-seekling behaviour for post partum morbidity among mothers in Enugu south east, Nigeria. Niger J Med. 2010;20(2):260–5.
59.
Mwangome F, Holding P, Songola K, Bomu G. Barriers to hospital delivery in a rural setting in Coast Province, Kenya: community attitude and behaviours. Rural Remote Health. 2012;12(2):1852.PubMed
60.
Magadi MA, Madise NJ, Rodrigues RN. Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. Soc Sci Med. 2000;51(4):551–61.CrossRef
61.
Mathole T, Lindmark G, Majoko F, Ahlberg BM. A qualitative study of women's perspectives of antenatal care in a rural area of Zimbabwe. Midwifery. 2004;20(2):122–32.CrossRef
62.
Kyomuhendo GB. Low use of rural maternity services in Uganda: impact of women's status, traditional beliefs and limited resources. Reprod Health Matters. 2003;11(21):16–26.CrossRef
63.
Rwenge MJ-R, Tchamgoue-Nguemaleu HB. Facteurs sociaux de l'utilisation des services de soins obstétricaux parmi les adolescentes camerounaises. Afr J Reprod Health. 2011;15(3):81–92.PubMed
64.
Adjamagbo A, Guillaume A. La santé de la reproduction en milieu rural ivoirien. Autrepart. 2001;(3):11–27.CrossRef
65.
Abel Ntambue ML, Malonga F, Dramaix-Wilmet M, Donnen P. Determinants of maternal health services utilization in urban settings of the Democratic Republic of Congo–a case study of Lubumbashi City. BMC Pregnancy Childbirth. 2012;12(1):66.CrossRef
66.
Beninguissé G. Entre tradition et modernité: fondements sociaux de la prise en charge de la grossesse et de l'accouchement au Cameroun. Editions L’Harmattan ed 2003.
67.
Bedford J, Gandhi M, Admassu M, Girma A. ‘A normal delivery takes place at home’: a qualitative study of the location of childbirth in rural Ethiopia. Matern Child Health J. 2013;17(2):230–9.CrossRef
68.
Myer L, Harrison A. Why do women seek antenatal care late? Perspectives from rural South Africa. J Midwifery Womens Health. 2003;48(4):268–72.CrossRef
69.
Ganle JK, Parker M, Fitzpatrick R, Otupiri E. A qualitative study of health system barriers to accessibility and utilization of maternal and newborn healthcare services in Ghana after user-fee abolition. BMC Pregnancy Childbirth. 2014;14(1):425.CrossRef
70.
Niang M, Dupéré S, Bédard E. Le non-recours aux soins prénatals au Burkina Faso. Santé Publique. 2015;27(3):405–14.CrossRef
71.
Gabrysch S, Cousens S, Cox J, Campbell OM. The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med. 2011;8(1):1000394.CrossRef
72.
Pembe AB, Urassa DP, Darj E, Carlstedt A. Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice. Afr J Reprod Health. 2008;12(2):120–31.PubMed
73.
Hailu D, Berhe H. Determinants of institutional childbirth service utilisation among women of childbearing age in urban and rural areas of Tsegedie district, Ethiopia. Midwifery. 2014;30(11):1109–17.CrossRef
74.
Rai RK, Singh PK, Singh L, Kumar C. Individual characteristics and use of maternal and child health services by adolescent mothers in Niger. Matern Child Health J. 2014;18(3):592–603.CrossRef
75.
Mason KO. The impact of Women's social position on fertility in developing countries. Sociol Forum. 1987;2(4):718–45.CrossRef
76.
Kumbani L, Bjune G, Chirwa E, Odland JØ. Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural southern Malawi. Reprod Health. 2013;10(1):9.CrossRef
77.
Ricard L. L’autonomie relationnelle : un nouveau fondement pour les théories de la justice. Philosophiques. 2013;401:139–69.CrossRef
78.
Dove ES, Kelly SE, Lucivero F, Machirori M, Dheensa S, Prainsack B. Beyond individualism: is there a place for relational autonomy in clinical practice and research? Clin Ethics. 2017;12(3):150–65.CrossRef
79.
Donagan B. The origins of English individualism: the family, property and social transition. Alan Macfarlane. Ethics. 1980;91(1):168–70.CrossRef
80.
Christman J. Relational autonomy, Liberal individualism, and the social constitution of selves. Philos Stud. 2004;117(1/2):143–64.CrossRef
81.
Donchin A. Understanding autonomy relationally: toward a reconfiguration of bioethical principles. J Med Philos. 2001;26(4):365–86.CrossRef
82.
Baylis F, Kenny NP, Sherwin S. A relational account of public health ethics. Public Health Ethics. 2008;1(3):196–209.CrossRef
83.
Gage AJ. Barriers to the utilization of maternal health care in rural Mali. Soc Sci Med. 2007;65(8):1666–82.CrossRef
84.
Edmonds JK, Hruschka D, Bernard HR, Sibley L. Women’s Social Networks and Birth Attendant Decisions: application of the network-episode model. Soc Sci Med. 2012;74(3):452–9.CrossRef
85.
St Clair PA, Smeriglio VL, Alexander CS, Celentano DD. Social network structure and prenatal care utilization. Med Care. 1989;27(8):823–32.CrossRef
86.
Helleringer S, Kohler HP. Social networks, perceptions of risk, and changing attitudes towards HIV/AIDS: new evidence from a longitudinal study using fixed-effects analysis. Popul Stud. 2005;59(3):265–82.CrossRef
Metadata
Title
Sociocultural determinants of nomadic women’s utilization of assisted childbirth in Gossi, Mali: a qualitative study
Authors
M.A. Ag Ahmed
L. Hamelin-Brabant
M.P. Gagnon
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-2027-3

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