[What sociotechnical arrangement is responsible for newborn deaths in West Africa?].

INTRODUCTION

In Sub-Saharan Africa, despite the establishment of many health care programs, neonatal mortality rates remain extremely high. From a medical point of view, the main causes are obstetric, along with diarrhea and pneumonia. Understanding how these risks and pathogenic situations are constructed cannot be achieved without observing, analyzing, and understanding the underlying gestures and meaning systems.

METHOD

Rather than describing obvious inequalities in the access to health care, our study aimed at questioning the different actors' operational capacities and at considering what is actually possible to improve in the most common healthcare situations. More specifically, how are births, neonatal care, and popular practices carried out in the first days of the lives of these newborns? In five countries of West Africa, a "multi-sited" anthropological study was carried out to observe the first weeks of newborns. This study not only allowed for the methodical identification of care interactions at and around childbirth in peripheral health care services, but also the popular practices related to the socialization of the child in family settings.

RESULTS

Our fieldwork investigations show that neonatal risk corresponds to the combination of several sets of behavior. In obstetric services, for reasons linked to the symbolic status of the child as much as to a certain idea of the obstetric profession, the newborn remains marginal in the preoccupations of the midwives. This results in many dysfunctions (not warming the child, leaving the child in a drafty area, not feeding the child…) which constitute discontinuous risk factors.In the village and in the family, the newborn is at the center of many social practices - baths, rituals, ingestions of various "protective" products, period of seclusion, baptism… - which not only aim at conferring an identity and including the infant in the social group, but also build a set of infectious risks.Finally, while health actions build a translation space, no preventive dialogue has been established by healthcare personnel to inform people about the risks associated with certain social practices.Overall, these longitudinal follow-ups of newborns, as well as precise observations and interviews conducted with the actors on their reasons for acting, have made it possible to analyze the attitudes, gestures and social behaviors that constitute the concrete causes of neonatal risk.

DISCUSSION

Describing the practices that newborns "benefit from" during their first days is essential to concretely identify and analyze the risks and reasons for high neonatal mortality. The empirical and documented approach of anthropology is essential to carry out these studies. But, more importantly, this qualitative approach must be implemented in vivo and in situ in the health services and during the training of health personnel to create a reflexivity of the caregivers and to initiate professional practices concerned with newborns. In the same way, our studies open the way for precise and documented dialogues with families which will enable the indispensable follow-up care for the newborns and ensure adapted preventive care and coherence in the care provided by the healthcare structures, the families, and the collectivities.