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The determinants of the use or non-use of childbirth by nomadic women in Gossi in Mali and the potential strategies to facilitate it

Thesis

French

ID: <http://hdl.handle.net/20.500.11794/37992>

Abstract

Context : More than half of all maternal deaths worldwide occur in sub-Saharan Africa (SSA). In Mali, the maternal mortality ratio was 368 maternal deaths per 100,000 live births in 2012. This maternal mortality is largely dependent on the non-use of assisted delivery. For nomadic pastoralists (30 to 60 million) in SSA, the risk of maternal death is very high because of the low proportions of assisted deliveries in the areas where they live. The objective of this research is to understand, on the one hand, the reasons why nomadic women do not use assisted childbirth in the commune of Gossi in Mali and, on the other hand, to explore potentially promising strategies for its facilitation. Methodology : This qualitative research was conducted in the commune of Gossi (Mali), of which 90 % of the population is nomadic. The study population consists of 26 nomadic women living in their camps who have given birth during the three months preceding our data collection, be it in a health center or not. Our sampling strategy was guided by the principles of saturation and diversification. Semi-structured individual interviews, logbook and nonparticipant observation allowed concomitant collection of the data. We performed thematic content analysis using the QDA Miner analysis software. Results : This research has made it possible to identify the determinants of the use or non-use of assisted childbirth by nomads. These determinants are of a socio-cultural nature, on the one hand, and on the other hand, in relation to the perceptions of their quality and economic and geographic accessibility of health services. Among the 26 participants, ten used assisted childbirth. These seem to better measure the nature of the risks to which they expose themselves by giving birth at home. In addition, the use of assisted delivery was facilitated by the existence of a social network formed by relatives, friends and neighbors. Also, they think that health workers are competent and well trained, and they appreciate the fact that they are recruited locally. Similarly, they judge their attitude acceptable through the reception they receive and their availability. In contrast, the majority of participants in this study (16 women) were prevented or discouraged from assisted delivery due to several determinants. Indeed, they perceive childbirth as a normal phenomenon that does not require medical attention. Others have been unable to use it because of their limited autonomy to make decisions that are strongly linked to their limited economic power and mobility. Finally, some of them did not use assisted delivery because of their perceptions of the quality and accessibility of health services. Indeed, they are afraid of being undressed, to give birth on a table and especially be seen by male staff. For these women, unassisted birth is associated with courage, bravery and pride. Also, they say they do not have access to information about health services. In addition, these health services are difficult for them to access because of distances, unavailable means of transportation, and their costs perceived as expensive. In addition, this study identified four strategies used by nomads which could facilitate their use of assisted delivery. These are mobile telephony, waiting homes, parturient transportation and community extensions. For the women interviewed, these services could be better organized to improve the use of assisted delivery. Conclusion : This research allowed access to the experiences and perspectives of nomadic women which are not well studied in the scientific literature, making it a major contribution to current knowledge. Our results confirm that nomadic women have little recourse to assisted delivery. They identify several explanatory determinants of the use or non-use of assisted childbirth in relation to their context and way of life. In addition, our findings call for future research to better understand these determinants and to deepen, refine and test the emerging strategies that seem potentially hopeful to facilitate the use of assisted delivery. Keywords: Nomads, assisted childbirth, determinants, Sub-Saharan Africa, Mali

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