Carol P. MacCormack

The Cultural Context of Therapeutic Choice: Obstetrical Care Decisions Among the Bariba of Benin.

1: Introduction.- 1.1. The Study.- 1.2. The Setting.- 1.3. Methodology.- 1.4. Theoretical Perspectives on Health Care Decisions.- 2: The Cultural Context of Therapeutic Choice.- 2.1. Bariba Conceptions of the Order of the Universe.- 2.2. Diagnosis and Treatment.- 2.3. Divination.- 2.4. The Use of Substances.- 2.5. Medicines.- 3: Beliefs and Practices Surrounding Reproductive Processes.- 3.1. Menstruation and Clitoridectomy.- 3.2. Conception.- 3.3. Development of Fetus.- 3.4. Contraception.- 3.5. Abortion.- 3.6. Sterility.- 4: Status Among the Bariba: The Roles and Responsibilities of Women.- 4.1. Status in Bariba Society.- 4.2. Position of Women.- 4.3. Economic Subsistence.- 4.4. Political Arena.- 4.5. Domestic Relations.- 4.5.1. Marriage.- 4.6. Household Responsibilities.- 5: Sociological and Career Attributes of Midwives.- 5.1. Healers: Midwives and Medicine People.- 5.1.1. Tingi: The Medicine Person.- 5.1.2. Apprenticeship.- 5.1.3. The Power of Words.- 5.1.4. Midwife as Healer.- 5.1.5. Midwife as a Category.- 5.2. Implications of Role Expectations for Birth Assistance.- 5.2.1. Status Characteristics of Midwives.- 5.2.1.1. Religion.- 5.2.1.2. Age.- 5.2.1.3. Birth and Residence.- 5.2.1.4. Education.- 5.2.1.5. Marital Status.- 5.2.1.6. Occupation of Husband.- 5.2.1.7 Family Origin.- 5.3. Recruitment of Matrones and Method of Skill Acquisition.- 5.4. Sources of Medical Knowledge.- 5.5. Matrones Own Reproductive Histories.- 5.6. Age at Unsupervised Delivery.- 5.7. Assistance at Own Childs Delivery.- 5.8. Remuneration.- 5.9. Comprehensive Care by Matrones.- 5.10. Pregnancy Counseling.- 5.11. Matrones Role Variability.- 5.12. Spirit Possession.- 5.13. Inheritance of Spirits.- 5.14. Healing and Sambani.- 5.15. The Matrone Prototype.- 6: The Meaning of Efficacy in Relation to Obstetrical Care Preferences.- 7: Birth Assistance in the Rural Area: Patterns of Delivery Assistance.- 7.1. Delivery Assistance: Patterns of Selection in the Rural Area.- 7.1.1. Person Present at Last Delivery.- 7.1.2. Clients and Cord-Cutters.- 7.1.3. The Baby-Washer.- 7.2. Midwifery as a Therapeutic System.- 7.3. Structured Interviews with Matrones.- 8: Client-Practitioner Encounters.- 8.1.1. The Case of Adama.- 8.1.1.1. Comments.- 8.1.2. The Case of Sako.- 8.1.2.1. Comments.- 8.1.3. The Case of the Prolapsed Cord.- 8.1.3.1. Comments.- 8.1.4. The Case of the Terrifying Breech 120.- 8.1.4.1. Comments.- 8.1.5 The Case of Bona.- 8.1.5.1. Comments.- 8.2. Pain as a Cultural Phenomenon.- 8.3. Pregnancy (by Nicole).- 8.4. Conclusion.- 9: Utilization of National Health Services for Maternity Care in the District of Kouande.- 9.1. Clinic vs. Home Delivery: A Pehunko Sample.- 9.2. Utilization of the Pehunko Dispensary.- 9.2.1. Summary Points.- 9.3. Pehunko Women at the Kouande Maternity Clinic.- 9.3.1. Summary Points.- 9.4. The Kouande Maternity Clinic: General Utilization.- 9.4.1. Distance.- 9.4.2. Prenatal Consultations.- 9.4.3. Reasons for Utilizing the Clinic.- 9.4.4. Features of the Model.- 9.4.5. Morbidity and Mortality.- 9.4.6. The Etic Perspective.- 9.4.7. The Clinic Setting.- 9.4.8. The Emic Perspective.- 10: Conclusion.- 10.1. Implications of the Bariba Study for the Cross-Cultural Study of Midwifery.- 10.2. The Involvement of Indigenous Midwives in National Health Systems.- 10.3. Training Programs.- Appendices.- Appendix A: Demographic Data.- Appendix B: Female Circumcision Songs.- Notes.

Health care and the concept of legitimacy

Abstract Health sector planning is here analyzed in terms of three forms of social legitimacy put forward by Max Weber: rational-legal, traditional and charismatic. Health care planning which is completely legitimated by rational-legal means in bureaucratic institutions usually leaves populations at the periphery of the system ill-provisioned, especially in societies such as many in Africa in which productive resources are in the rural countryside. A proposal is offered for the integration of legal-rational health care organization with traditional health care such that both sectors serve best for that which they are qualified, although not at the expense of the other.

Primary health care in Sierra Leone

Two pilot primary health care programmes are compared. One is primarily concerned with covering the national population by the year 2000; the other is more concerned with community participation and culturally-appropriate health care organisation. Strengths and weaknesses of the two pilot programmes are assessed in relation to national financial constraints, epidemiological patterns, and the socio-cultural structure of rural chiefdoms. The comparison concludes with specific recommendations for a national programme which incorporates the best of both pilot programmes.