Université Laval, 1050 Avenue de la Médecine, room 3696, Québec, G1V 0A6, Canada.
Faculty of Nursing Sciences, Université Laval, 1050 Avenue de la Médecine, room 3447, Québec, G1V 0A6, Canada.
BMC Pregnancy Childbirth. 2018 Oct 3;18(1):388. doi: 10.1186/s12884-018-2027-3.
In sub-Saharan Africa (SSA), nomads account for 30 to 60 million people. Their mobility, due to a constant search for pastures and water points, makes health services less accessible to them. Few nomadic women use assisted delivery, which increases the risk of maternal mortality. The reasons behind this limited use have been poorly documented. The objective of this study was to understand the sociocultural determinants of assisted childbirth by nomadic women.
We conducted a qualitative research in the health area of Gossi (Mali), mainly populated by nomads. Data were collected through a literature review, 26 semi-structured interviews, a non-participant observation, and a logbook. Nomadic women who gave birth in the past three months were included in the study, whether they used assisted delivery or not. A thematic content analysis was performed with QDA Miner software.
The study identified a complex combination of determinants resulting in the use or non-use of assisted childbirth by the nomads of Gossi. Several participants recognized the value of assisted delivery but gave birth at home. They identified sociocultural determinants related to their representations and bodily experiences; the risks and emotions (fear, stress, anxiety) associated with pregnancy; the onset of labor and delivery; and their weak autonomy in terms of movement, decision-making, and economic agency. Nomadic women are not free in their movements, and in order to seek care, they require the permission and support of a man (husband, brother, or father). Furthermore, the participants are housewives, and men control family resources and make decisions regarding all financial matters. Assisted delivery is often only considered when there are complications.
This research has made it possible to understand the sociocultural determinants of the use of assisted childbirth among nomadic women, which should be taken into account when organizing health services for these populations.
在撒哈拉以南非洲（SSA），游牧民人数为 3000 万至 6000 万。由于不断寻找牧场和水源，他们的流动性使他们难以获得卫生服务。很少有游牧妇女使用辅助分娩，这增加了产妇死亡的风险。造成这种有限使用的原因记录甚少。本研究的目的是了解游牧妇女辅助分娩的社会文化决定因素。
我们在主要由游牧民居住的戈西（马里）卫生区进行了定性研究。通过文献回顾、26 次半结构化访谈、非参与观察和日志收集数据。研究纳入了过去三个月内分娩的游牧妇女，无论她们是否使用了辅助分娩。使用 QDA Miner 软件对主题内容进行了分析。
研究确定了一系列复杂的决定因素，这些因素导致戈西的游牧民使用或不使用辅助分娩。一些参与者认识到辅助分娩的价值，但在家里分娩。他们确定了与他们的表现和身体体验相关的社会文化决定因素；与怀孕相关的风险和情绪（恐惧、压力、焦虑）；分娩开始；以及她们在行动、决策和经济代理方面的自主权较弱。游牧妇女的行动并不自由，为了寻求护理，她们需要得到男性（丈夫、兄弟或父亲）的许可和支持。此外，参与者是家庭主妇，男性控制家庭资源并决定所有财务事项。只有在出现并发症时，才会考虑辅助分娩。
这项研究使我们能够了解游牧妇女使用辅助分娩的社会文化决定因素，在为这些人群组织卫生服务时应考虑这些因素。
