Jointly conducted by IRD and INSERM, this research explores reproductive risks in Burkina Faso through an ethnographic approach.
Sophie Servais-Walenda, researcher at TransVIHMI (Institut de Recherche pour le Développement).
Thesis defended in 2018 at the doctoral school École doctorale Sciences Chimiques et Biologiques pour la Santé (Montpellier ; 1992-....).
This research is the result of an international co-supervision between several partner institutions.
Referenced in the ABES/STAR network, this thesis meets the rigorous criteria of French higher education.
Maternal health in Burkina Faso is a complex issue, often reduced to statistics and figures that, while revealing a certain reality, cannot alone account for the richness and depth of the experiences lived by women. Behind each data point lies a human reality, stories of women who face risks related to reproduction in a particular socio-cultural context. This ethnographic research highlights these lived experiences, revealing that women are not merely passive victims of health policies, but active agents who assess and prioritize the risks that concern them. They navigate a world where choices are often limited, but where their agency is very much present.
Maternal and child health policies, often based on a quantitative approach, have frequently overlooked the diversity of situations experienced by women. By focusing solely on indicators such as maternal mortality rates or the number of prenatal consultations, these policies have neglected the social and cultural contexts that influence the perception of risk. For example, in some rural areas, women may have limited access to healthcare, but they possess in-depth knowledge of local medicinal plants that can be used to treat common ailments. Women, through their experiences, remind us that risk is a social construct, shaped by personal and collective experiences, and that it is essential to consider these dimensions to fully understand maternal health.
The study also reveals a normalization of HIV/AIDS risk, despite the persistence of the social stigma surrounding it. Women share their concerns about exposure to pesticides, often used in their work environment, particularly in agriculture, where intensive farming practices are becoming increasingly common. This exposure can have serious consequences for their health and that of their unborn children. Furthermore, they express a growing distrust of the healthcare system, perceived as a threat rather than a support. This crisis of confidence is reflected in the mistreatment experienced during pregnancy, exacerbating risks for maternal and child health. Testimonies from women who have been mistreated during childbirth in healthcare facilities underscore the urgency of a thorough reform of the healthcare system.
The findings of this research highlight the importance of recognizing environmental risks and informal working conditions as major public health issues. Women often face precarious working conditions, without adequate protection, which increases their vulnerability. For example, agricultural workers, who handle chemicals without protective equipment, are at risk not only for their health but also for that of their children. Policymakers must take these realities into account to develop more appropriate and effective health policies.
By integrating women's voices and valuing their experiences, it is possible to transform the way we approach maternal health in West Africa. This requires a holistic approach that includes not only medical care but also educational initiatives and awareness programs on environmental risks. For example, awareness campaigns on the safe use of pesticides and training on women's health rights could help strengthen trust in the healthcare system. Moreover, it is crucial to involve women in the design and implementation of health policies so that they can express their needs and concerns. Ultimately, a woman-centered approach could not only improve maternal health but also strengthen the social and economic fabric of communities in Burkina Faso and beyond.
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Sources and Access
Sophie Servais-Walenda. La maternité avec risques : une analyse ethnographique des risques autour de la procréation au Burkina Faso. Médecine humaine et pathologie. Université Montpellier, 2018. Français. ⟨NNT : 2018MONTT056⟩. ⟨tel-01988120⟩