Fear, guilt, and debt: an exploration of women's experience and perception of cesarean birth in Burkina Faso, West Africa.
BACKGROUND
This paper explores women's experience and perception of cesarean birth in Burkina Faso and its social and economic implications within the household.


METHODS
Five focus groups comprising mothers or pregnant women were conducted among residents of Bogodogo Health District in Ouagadougou to assess the perceptions of cesarean section (CS) by women in the community. In addition, 35 individual semistructured interviews were held at the homes of women who had just undergone CS in the referral hospital, and were conducted by an anthropologist and a midwife.


RESULTS
Home visits to women with CS identified common fears about the procedure, such as "once you have had a CS, you will always have to deliver by CS". The central and recurring theme in the interviews was communication between patients and care providers, ie, women were often not informed of the imminence of CS in the delivery room. Information given by health care professionals was often either not explicit enough or not understood. The women received insufficient information about postoperative personal hygiene, diet, resumption of sexual activity, and contraception. Overall, analysis of the experiences of women who had undergone CS highlighted feelings of guilt in the aftermath of CS. Other concerns included the feeling of not being a "good mother" who can give birth normally, alongside concerns about needing a CS in future pregnancies, the high costs that this might incur for their households, general fatigue, and possible medical complications after surgery.


CONCLUSIONS
Poor quality of care and the economic burden of CS place women in a multifaceted situation of vulnerability within the family. CS has a medical, emotional, social, and economic impact on poor African women that cannot be ignored. Managers of maternal health programs need to understand women's perceptions of CS so as to overcome existing barriers to this life-saving procedure.
Maternal and Reproductive Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
Fabienne
F
Richard
Institut de Recherche pour le Développement, Burkina Faso, West Africa.
Sylvie
S
Zongo
Institut de Recherche pour le Développement UMR 912, "Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale - SESSTIM", Marseille, France.
Fatoumata
F
Ouattara
access to care; anthropology; cesarean section; quality of care