The Cultural Context of Therapeutic Choice

This book examines the factors influencing women's choices of obstetrical care in a Bariba community in the People's Republic of Benin, West Africa. When selecting a research topic, I decided to investigate health care among the Bariba for several reasons. First, I had served as a Peace Corps Volunteer in northern Benin (then Dahomey) and had established a network of contacts in the region. In addition, I had worked for a year as assistant manager of a pharmacy in a northern town and had become interested in the pattern of utilization of health care services by urban residents. This three-year residence proved an invaluable asset in preparing and conducting research in the northern region. In particular, I was able to establish relationships with several indigenous midwives whose families I already knew both from prior research experience and mutual friend ships. These relationships enabled me to obtain detailed information regarding obstetrical practice and thus form the foundation of this book. The fieldwork upon which the book is directly based was conducted between June 1976 and December 1977 and sponsored by the F ord-Rockefeller Popula tion Policy Program, the Social Science Research Council, the National Science Foundation, and the FUlbright-Hays Doctoral Dissertation Research Program. The Ford-Rockefeller Population Policy Program funded the project as a collab oration between myself and Professor Eusebe Alihonou, Professor Agrege (Gynecologie-Obstetrique) at the National University of Benin.

Klappentext

This book examines the factors influencing women's choices of obstetrical care in a Bariba community in the People's Republic of Benin, West Africa. When selecting a research topic, I decided to investigate health care among the Bariba for several reasons. First, I had served as a Peace Corps Volunteer in northern Benin (then Dahomey) and had established a network of contacts in the region. In addition, I had worked for a year as assistant manager of a pharmacy in a northern town and had become interested in the pattern of utilization of health care services by urban residents. This three-year residence proved an invaluable asset in preparing and conducting research in the northern region. In particular, I was able to establish relationships with several indigenous midwives whose families I already knew both from prior research experience and mutual friend­ ships. These relationships enabled me to obtain detailed information regarding obstetrical practice and thus form the foundation of this book. The fieldwork upon which the book is directly based was conducted between June 1976 and December 1977 and sponsored by the F ord-Rockefeller Popula­ tion Policy Program, the Social Science Research Council, the National Science Foundation, and the FUlbright-Hays Doctoral Dissertation Research Program. The Ford-Rockefeller Population Policy Program funded the project as a collab­ oration between myself and Professor Eusebe Alihonou, Professor Agrege (Gynecologie-Obstetrique) at the National University of Benin.

Inhalt
1: Introduction.- 1.1. The Study.- 1.2. The Setting.- 1.3. Methodology.- 1.4. Theoretical Perspectives on Health Care Decisions.- 2: The Cultural Context of Therapeutic Choice.- 2.1. Bariba Conceptions of the Order of the Universe.- 2.2. Diagnosis and Treatment.- 2.3. Divination.- 2.4. The Use of Substances.- 2.5. Medicines.- 3: Beliefs and Practices Surrounding Reproductive Processes.- 3.1. Menstruation and Clitoridectomy.- 3.2. Conception.- 3.3. Development of Fetus.- 3.4. Contraception.- 3.5. Abortion.- 3.6. Sterility.- 4: Status Among the Bariba: The Roles and Responsibilities of Women.- 4.1. Status in Bariba Society.- 4.2. Position of Women.- 4.3. Economic Subsistence.- 4.4. Political Arena.- 4.5. Domestic Relations.- 4.6. Household Responsibilities.- 5: Sociological and Career Attributes of Midwives.- 5.1. Healers: Midwives and Medicine People.- 5.2. Implications of Role Expectations for Birth Assistance.- 5.3. Recruitment of Matrones and Method of Skill Acquisition.- 5.4. Sources of Medical Knowledge.- 5.5. Matrones Own Reproductive Histories.- 5.6. Age at Unsupervised Delivery.- 5.7. Assistance at Own Child's Delivery.- 5.8. Remuneration.- 5.9. Comprehensive Care by Matrones.- 5.10. Pregnancy Counseling.- 5.11. Matrone's Role Variability.- 5.12. Spirit Possession.- 5.13. Inheritance of Spirits.- 5.14. Healing and Sambani.- 5.15. The Matrone Prototype.- 6: The Meaning of Efficacy in Relation to Obstetrical Care Preferences.- 7: Birth Assistance in the Rural Area: Patterns of Delivery Assistance.- 7.1. Delivery Assistance: Patterns of Selection in the Rural Area.- 7.2. Midwifery as a Therapeutic System.- 7.3. Structured Interviews with Matrones.- 8: Client-Practitioner Encounters.- 8.1.1. The Case of Adama.- 8.1.2. The Case of Sako.- 8.1.3. The Case of theProlapsed Cord.- 8.1.4. The Case of the Terrifying Breech 120.- 8.1.5 The Case of Bona.- 8.2. Pain as a Cultural Phenomenon.- 8.3. Pregnancy (by Nicole).- 8.4. Conclusion.- 9: Utilization of National Health Services for Maternity Care in the District of Kouande.- 9.1. Clinic vs. Home Delivery: A Pehunko Sample.- 9.2. Utilization of the Pehunko Dispensary.- 9.3. Pehunko Women at the Kouande Maternity Clinic.- 9.4. The Kouande Maternity Clinic: General Utilization.- 10: Conclusion.- 10.1. Implications of the Bariba Study for the Cross-Cultural Study of Midwifery.- 10.2. The Involvement of Indigenous Midwives in National Health Systems.- 10.3. Training Programs.- Appendices.- Appendix A: Demographic Data.- Appendix B: Female Circumcision Songs.- Notes.