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Edwige Sawadogo sits on a bench in the big waiting room of the Boussouma health centre, about 100 kilometres north of Ouagadougou, the capital of Burkina Faso. Other pregnant women come and go, and bursts of laughter from the medical staff occasionally break the silence that reigns in the hallways.
Mrs. Sawadogo is seven months pregnant with her fifth child, and is a bit worried. It’s the first time that the 40-year-old mother has consulted a doctor. To shake off her anxiety, she chats with the midwives and tries to reassure herself.
She says, “I don’t have any health problems. I eat well, I prepare my dolo, and every three days I go to the market to sell it. So I don’t find it necessary to consult a doctor.”
Mrs. Sawadogo sells dolo, a local beer. She says she didn’t have time to see a doctor during her first six months of pregnancy. But the promise that she would be vaccinated and receive midwifery services during childbirth convinced her to come.
Pregnant women like Mrs. Sawadogo face many obstacles that can prevent them from seeing a doctor, including their workload, beliefs, and cultural norms. But health professionals are offering services and information that they hope will encourage women to attend prenatal visits.
Abibou Ouédraogo became pregnant for the second time when her first baby was less than a year old. Villagers and health workers both disapprove of closely-spaced pregnancies, and the mothers are stigmatized. Mrs. Ouédraogo concealed her pregnancy for the first six months, and only came to the health centre when she could no longer hide her belly.
She says: “I don’t want to be the laughing stock; the other women will make fun of me, as will the health workers who advise us to avoid closely-spaced pregnancies…. That’s why I didn’t consult a doctor earlier.”
For her first pregnancy, it was different. After participating in a ceremony to officially announce that she was expecting a child, Mrs. Ouédraogo had permission from her husband’s family to talk about and show her pregnancy.
In some parts of Burkina Faso, it’s common for a woman to need her husband’s or her parents’ approval before making important decisions. Some families also prefer to treat their pregnant daughter-in-law with plant remedies rather than letting her see a doctor.
Sibiri Pascal Nébié lives in Godin village, 100 kilometres west of Ouagadougou. He says pregnant women have many reasons for not accessing health services during pregnancy. He explains: “Some women don’t want to leave the house in early pregnancy. It’s the husband’s fault…. There are men who stand in the way if it’s a question of money. [But] The consultation is necessary for health reasons, and no one should prevent that.”
A woman’s many household chores can also be an obstacle, according to Marie Oualbéogo, a Godin resident in her 50s. She says the reality in many villages is that women are the first to get up in the morning and the last to go to bed at night. They fetch water, collect firewood, prepare meals, and care for the children. Mrs. Oualbéogo says these duties keep them busy all day, leaving little time to get to the clinic. If there were more health centres in the villages, she says women could consult more easily.
She adds: “For some it’s their workload, and for others it’s the distance. When a woman doesn’t have the time or the means to travel, she may arrive late and then she has to go back another time, which is discouraging.”
Justin Kaboré is the head nurse at the Godin health centre. He says prenatal visits are quick, and he thinks that “the problem is largely due to the fact that women don’t understand the importance of the prenatal visit.”
But the consequences of waiting until late in pregnancy for a prenatal visit have convinced some pregnant women to change their approach in order to avoid newborns dying of infections or of anemia during childbirth or shortly thereafter.
Statistics from Burkina Faso’s health ministry show that about one in five pregnant women attend regular prenatal consultations. But the rates are higher in Godin, a village of about 13,000 people. In 2017, half of the pregnant women in the village had a prenatal visit at the village’s health centre, although many of them did not make the recommended number of visits during their pregnancies.
During a prenatal visit, a pregnant woman can learn how to protect her baby from malaria and anemia. Since 2016, pregnant women and children up to five years old have been receiving free healthcare and mosquito nets to help reduce the risk of malaria, which is a leading cause of miscarriage, premature births, and low birth weight babies in Burkina Faso.
This story was originally published in July 2018.
This work was created with the support of the Government of Canada, through Global Affairs Canada, as part of the project, “Projet d’Amélioration de la Santé des Mères et des Enfants.” This work is implemented by World University Service of Canada (WUSC) in partnership with BURCASO (Conseil Burkinabé des ONG, OBC et Associations de lutte contre les IST/VIH/SIDA) and SEMUS (Solidarité et entraide mutuelle au Sahel).
Photo: Edwige Sawadogo and Justin Kaboré