Jaffré Yannick
Sante Publique. 2020;HS1(S1):29-43. doi: 10.3917/spub.200.0029.
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.
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.
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.
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.
在撒哈拉以南非洲地区，尽管已经建立了许多医疗保健项目，但新生儿死亡率仍然极高。从医学角度来看，主要原因是产科问题，以及腹泻和肺炎。如果不观察、分析和理解潜在的行为和意义系统，就无法了解这些风险和致病情况是如何形成的。
我们的研究并非描述获得医疗保健方面明显的不平等现象，而是旨在质疑不同行为者的操作能力，并考虑在最常见的医疗保健情况下实际能够改善的方面。更具体地说，这些新生儿生命最初几天的分娩、新生儿护理和大众习俗是如何进行的？在西非的五个国家开展了一项“多地点”人类学研究，以观察新生儿的最初几周。这项研究不仅有助于系统地识别周边医疗保健服务中分娩时及分娩前后的护理互动，还能识别与家庭环境中儿童社会化相关的大众习俗。
我们的实地调查表明，新生儿风险是多种行为组合的结果。在产科服务中，由于与儿童的象征地位以及对产科职业的某种观念相关的原因，新生儿在助产士的关注中仍然处于边缘地位。这导致了许多功能失调（不给孩子保暖、让孩子处于通风处、不给孩子喂食……），这些构成了间断性的风险因素。在村庄和家庭中，新生儿是许多社会习俗的核心——洗澡、仪式、摄入各种“保护性”产品、隔离期、洗礼……——这些习俗不仅旨在赋予婴儿身份并将其纳入社会群体，还构建了一系列感染风险。最后，虽然医疗行动构建了一个转化空间，但医护人员尚未开展预防性对话，告知人们某些社会习俗相关的风险。总体而言，这些对新生儿的纵向跟踪，以及与行为者就其行为原因进行的精确观察和访谈，使得分析构成新生儿风险具体原因的态度、行为和社会行为成为可能。
描述新生儿在生命最初几天“受益于”的习俗对于具体识别和分析新生儿高死亡率的风险及原因至关重要。人类学的实证和文献研究方法对于开展这些研究至关重要。但更重要的是，这种定性方法必须在卫生服务机构内部以及卫生人员培训过程中在实际场景中实施，以促使护理人员进行反思，并启动与新生儿相关的专业实践。同样，我们的研究为与家庭进行精确且有文献依据的对话开辟了道路，这将为新生儿提供不可或缺的后续护理，并确保卫生保健机构、家庭和社区提供的预防性护理和连贯性护理相适应。
