@article{fdi:010074477,
  title = {{A}voiding a "big" baby : local perceptions and social responses toward childbirth-related complications in {M}enabe, {M}adagascar},
  author = {{P}ourette, {D}olores and {P}ierlovisi, {C}. and {R}andriantsara, {R}. and {R}alcotomanana, {E}. and {M}attern, {C}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}n {M}adagascar, a country where over 60% of deliveries are not attended by a healthcare professional, late or inadequate responses to complications during childbirth account for a great number of maternal deaths. {I}n this article, we analyse local perceptions of birth-related risks and strategies used to avoid these risks or manage complications of childbirth. {W}e conduct this analysis in light of the social meanings of childbirth and the social expectations placed upon women in a context of socio-economic vulnerability and a challenged public health system. {W}e conducted two separate studies in the district of {M}orondava ({M}enabe region) in {J}une 2014 and {M}arch 2015, comprising semi-directive interviews with 111 people (59 mothers, 18 members of their immediate entourage and 34 institutional or healthcare stakeholders), and eight focus groups discussions two with community leaders, and six with fathers. {T}he results show that the social pressure exerted on women to give birth without complications leads them to practices aimed at avoiding a "big" baby including dietary restrictions, physical activity, and refusal of iron supplementation intake. {D}uring pregnancy, women are usually accompanied by a traditional birth attendant or matron (reninjaza). {F}urther, they use the public health system by attending antenatal consultations. {H}owever, women are reluctant to deliver in a health facility, where the practices of health professionals are in discordance with the social realities of women and local beliefs around childbirth. {I}f complications arise, they are explained by social causes. {T}he parturient woman is only taken to a healthcare facility after carrying out rituals and if the problems do not resolve themselves. {T}hese findings support recommendations to reduce the cultural distance between health workers and childbearing women, strengthen the collaborations with reninjazas, and inform women and their decision makers (mother, reninjaza, spouse) about nutrition during pregnancy and signs of complications.},
  keywords = {{M}adagascar ; {M}aternal mortality ; {C}hildbirth-related complications ; {L}ocal knowledge ; {P}regnant women's care pathways ; {A}nthropological approach ; {MADAGASCAR}},
  booktitle = {},
  journal = {{S}ocial {S}cience and {M}edicine},
  volume = {218},
  numero = {},
  pages = {52--61},
  ISSN = {0277-9536},
  year = {2018},
  DOI = {10.1016/j.socscimed.2018.10.002},
  URL = {https://www.documentation.ird.fr/hor/fdi:010074477},
}