Traumatic Hospital Visit
Aminata, a 30-something mother of five children, has traumatic memories of giving birth in the Andokoua-Abobo health center in the suburbs of Abidjan.
Despite her contractions, she walked to the center, where she was immediately given two doses of a serum intended to speed up her labor – without requesting it. Her hand quickly began to swell, but the midwife did not come to check on her.
Once her baby was born, “air entered and dried the blood inside of me,” as she explained to sociologists Yannick Jaffré and Jean-Pierre Olivier de Sardan, authors of the report titled "Une médecine inhospitalière" (Inhospitable medicine, difficult relations between medical staff and patients in five West African capitals.)
“She removed the first blood clot, and it hurt; the second too,” said Aminata of the midwife. “For the third one, I refused. It really hurt. I said I would do it myself at home.”
Women face greater risks
According to the authors, Aminata’s testimony encapsulates the risks involved in medical care for women in some countries. In West Africa where women represent 80% of the patients treated in primary health care centers, they are the first to suffer the effects of dysfunctional healthcare systems.
From difficulties getting to the center to erroneous diagnoses, to a lack of basic post-natal care, Aminata endured serious problems at every step of her care.
Long hidden, these system failures put the health of millions of female patients, and of their children in danger.
Change may be underway. “With the gradual inclusion of gender equality in the discussion of development policies, it has become clear that we need to treat women’s uses of medical services differently, and better identify their specific needs,” says Anne Roos-Weil, a gender advisor with the Health Division of Agence Française de Développement (AFD).
The weight of taboos
The first challenge was to improve the way female patients are cared for by healthcare staff: “What we observe is that many healthcare professionals come to their patients with preconceived notions of what should be done; they position themselves as the sole experts, not as listeners,” says Roos-Weil. “There is a need for serious training in this area.”
Women on modest incomes or lack education may be less likely to speak up about their needs, and in many countries, taboos tend to affect how people speak about their bodies. “They often feel they would not be justified in asking a healthcare provider questions,” says Anne Roos-Weil.
Another major challenge is raising awareness among the women’s partners, who are largely absent when it comes to medical treatment, even when the family is directly affected, as in the case of obstetric and pediatric services. “Because healthcare is seen as a women’s issue’,” Anne Roos-Weil explains, “men feel it is not their place to get involved in these issues, learn about them, accompany their wives or, sometimes, even receive care themselves.”
A larger societal problem
What are the solutions to these challenges? Roos-Weil suggests a cross-disciplinary approach, which removes public health policy from isolated silos behind hospital walls, and makes it a topic of open societal discussion. “Gender discrimination is a larger societal problem. “The various projects we support therefore seek to influence different social spaces and target diverse populations.”
Some advocates argue that the one way to get a broader public interested in gender issues, is to make them fun. That’s the idea behind the TV series C’est la Vie! – an edutainment program (educational entertainment).
Characters with real-life health issues allows viewers to identify with them and with often taboo topics. And what about the male population? AFD is supporting AlloLaafia, a service for sending mass awareness-raising text messages that are customized based on gender. In Burkina Faso, it has proven effective in attracting male audiences (more than half of subscribers) and getting them involved in dealing with health issues.
Raising awareness about questions of gender is a major issue for healthcare professionals. In Chad, AFD supports a practical training program adapted to real conditions on the ground for all levels of the medical profession.
“As well as technical skills, partners of Expertise France, like MFPF (French Movement for Family Planning), train health workers to consider the obstacles women face in their access to services and rights,” says Anne Roos-Weill.
In Afghanistan, AFD contributes to the development of “gender-sensitive” structures: spaces designed for and dedicated to women. In Sidi Bouzid in Tunisia, AFD supports a participatory initiative in the design and organization of a hospital, in which regional women’s organizations will play a significant role in ensuring that their needs and expectations are taken into account at every stage.
AFD also supports countries that introduce funding systems aimed at alleviating the financial burden for obstetric care (obstetric package in Mauritania, health check in Cameroon, third-party payer system for obstetric care in the Comoros).
Not only should women be able to afford good healthcare. Just as important, mentalities will have to evolve for the quality of care to improve, too.