Strengthening endogenous micro-reforms to improve sexual and reproductive health services in three Sahelian countries (Mali, Mauritania, Niger)
The research of Dr Diarra, Doctor of Anthropology (EHESS Marseille, 2010), aims to examine micro-local reforms and innovations that could improve access to and use of sexual and reproductive health and family planning services, in particular in terms of quality of care and reduction of gender inequalities, in Mali, Niger and Mauritania.
The main objective is to examine endogenous strategies that could be relevant levers for improving access to and use of sexual and reproductive health services in Mali, Mauritania and Niger, particularly in terms of quality of care and reducing gender inequalities.
Investigating local micro-reforms and innovations in sexual health services in the Sahel
In the Sahel, access to and use of sexual and reproductive health services for women, mothers and adolescents are subject to three structural obstacles: gaps in the implementation of health programs, the ideologies of reference of the actors, and finally health, migration, security and economic crises. The prevalence of early marriages and clandestine induced abortions bears witness to the interweaving of these factors, and to particular forms of violence against women. However, despite these three obstacles and the problems they engender, we note the existence of positive endogenous micro-reforms and innovations produced by actors in the field with diverse profiles (on the side of the caregivers or on the side of the populations).
The overall aim of the research is to examine local micro-reforms and innovations that could improve access to and use of sexual and reproductive health and family planning services in Mali, Niger and Mauritania, particularly in terms of quality of care and reduction of gender inequalities.
Identifying obstacles to access to healthcare in the Sahel
In the Sahel, significant progress has been made in recent years in improving the health of women, mothers and children. Life expectancy has increased, and certain major causes of maternal and infant mortality have decreased. Nevertheless, current healthcare provision remains inadequate and does not meet women’s needs, particularly in Mali, Mauritania and Niger. At the heart of the multiple inequalities that make access to quality healthcare for all particularly difficult are discriminatory social norms that translate into attitudes, behaviors, policies and laws that hold back women and girls in particular.
Starting in 2020, the French Red Cross has implemented a 4-year project aimed at improving the health of women, mothers and their newborns in the Sahel by promoting women’s empowerment, adolescent awareness and access to better quality care by transforming the behavior of health professionals and relations between women and men.
Specifically, the “Programme Régional Genre Santé Sahel (PROGRESS)” aims to help improve Maternal and Child Health (MCH), Sexual and Reproductive Health (SRH) and Family Planning (FP) for populations in 3 areas of 3 different countries: one urban area (the district of Bamako, Mali) and two rural areas (the regions of Gorgol, Mauritania, and Zinder, Niger).
A study is needed to understand the mechanisms relating to gender relations and health systems specific to each context, and to identify the issues and possible outcomes specific to each intervention zone. Its overall aim is to identify gender-related obstacles to access to healthcare, particularly in terms of MCH-MRH-FP, as well as the levers by which these obstacles could be overcome in the three zones. Implemented during the first year of the program, the research will identify the determinants of gender inequalities in access to healthcare services, as well as the most appropriate responses to develop a transformative approach.
The study was carried out in Mali, Mauritania and Niger in 2020 and 2021. It was conducted using a qualitative methodology employing triangulation techniques, extended insertion, individual semi-directive interviews, focus groups, case studies and targeted observations in health facilities and in the community.
More concretely, the team carried out a review of the medical and social science literature, enabling a comparative analysis between countries; a collective exploratory survey in Mauritania and in-depth surveys in each country.
Proposals for humanitarian and social action
This research has two major implications for humanitarian and social action. The first is an invitation to renew the logic of intervention through a more detailed understanding of what is at stake in the implementation of programs “in real life” (local contexts) and by taking into account the perceptions of local actors, their selective appropriation of external proposals, and above all their own initiatives. The second is a training module for field workers, based on the results of the research, with the aim of helping participants to formulate “endogenous good practices” and to reflect on how they can be applied in practice, in order to strengthen the performance of the health system in terms of sexual and reproductive health.
Biography
Aïssa DIARRA is a doctor and socio-anthropologist. She is a researcher at the Laboratoire d’études et recherches sur les dynamiques sociales et le développement local (LASDEL), where she is in charge of the “health” unit. She specializes in maternal health issues in Africa, and works more broadly on health policies and systems on the one hand, and on power and gender relations on the other. She teaches health anthropology in e.formation and in the MASTER Anthropology of Health at the Abdou Moumouni University in Niamey (Niger). She holds a doctorate in social anthropology and ethnology (2010) from the École des Hautes Études en Sciences Sociales (EHESS Marseille), a university diploma in Health and Development (1999) from the Nancy-1 Faculty of Medicine (France), a post-graduate certificate (1998) in maternal and child health from the Centre International de l’Enfance et de la Famille (CIDEF, Paris), and a doctorate in medicine (1998) from the École Nationale de Médecine et de Pharmacie de Bamako (Mali).