title: Maternal healthcare in context: A qualitative study of women's tactics to improve their experience of public healthcare in rural Burkina Faso.
abstract: Improving the use of public maternal health facilities to prevent maternal death is a priority in developing countries. Accumulating evidence suggests that a key factor in choosing a facility-based delivery is the collaboration and the communication between healthcare providers and women. This article attempts to provide a fine-grained understanding of health system deficiencies, healthcare provider practices and women's experiences with maternal public healthcare. This article presents findings from ethnographic research conducted in the Central-East Region of Burkina Faso over a period of eight months (January-August 2013). It is based on monthly interviews with 14 women from village (10) and town (4) and on structured observations of clinical encounters in three primary healthcare facilities (two rural and one urban) (23 days). In addition, 13 health workers were interviewed and 11 focus groups with women from village (6) and town (5) were conducted (48 participants). Guided by an analytic focus on strategies and tactics and drawing on recent discussions on the notion of 'biomedical security', the article explores what tactics women employ in their efforts to maximize their chances of having a positive experience with public maternal healthcare. The synthesis of the cases shows that, in a context of poverty and social insecurity, women employ five tactics: establishing good relations with health workers, being mindful of their 'health booklet', attending prenatal care consultations, minimizing the waiting time at the maternity unit and using traditional medicines. In this way, women strive to achieve biomedical security for themselves and their child and to preserve their social reputation. The study reveals difficulty in the collaboration and communication between health workers and women and suggests that greater attention should be paid to social relations between healthcare providers and users.
authors.affiliation: Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark. Electronic address: liro@anthro.ku.dk.
authors.forename: Lise Rosendal
authors.initials: LR
authors.lastname: Østergaard
mesh_terms: D000884:Anthropology, Cultural; D001291:Attitude of Health Personnel; D002050:Burkina Faso; D003150:Community Health Workers / Q000331:legislation & jurisprudence; D036861:Delivery, Obstetric / Q000331:legislation & jurisprudence / Q000592:standards; D003906:Developing Countries; D005260:Female; D006282:Health Personnel; D006801:Humans; D008427:Maternal Health Services / Q000592:standards; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012424:Rural Population; D035502:Trust
keywords: Burkina Faso; Ethnography; Maternal healthcare; Patient tactics; Primary healthcare; Qualitative methods; Trust