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- Convenor:
-
Chrystelle Grenier-Torres
(Institut d'Etudes Politiques)
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- Location:
- C3.01
- Start time:
- 29 June, 2013 at
Time zone: Europe/Lisbon
- Session slots:
- 2
Short Abstract:
In a world where medical knowledge and technologies are greatly changing, health disparities still exist according to populations and geographical zones. This issue raises the question of the link between biopolitics (the governance of bodies by societies) and the way the actors experience it.
Long Abstract:
Although medical knowledge and technologies are greatly changing in the world, health disparities still exist according to populations and geographical zones, mainly between the North and the South. This issue raises questions of biopolitics (the governance of bodies by societies) and at the other end the actors' various personal experiences when they are faced with health problems. At another level, considering this discrepancy, one can wonder at what point the ethical issue which social and medical sciences can tackle, may contribute to rethinking this established order consisting in asserting the idea of a sort of global health which tends to contend the absence of such inequalities. If one keeps to the field of sexual and reproductive health, this raises the question namely of women's access to medical care during pregnancy, delivery or the treatment of PMTCT and the question of whole population 's access to medical care.
Accepted papers:
Session 1Paper short abstract:
The study presents the working and living conditions faced by female migrants who work as head porters in the commercial cities and how it affects their reproductive health.
Paper long abstract:
The study presents the working and living conditions that female migrants from the northern part of Ghana to the southern part of the country are going through in the urban and commercial cities in Ghana and how it impacts on their reproductive health. Female porters popularly known as "kayayei" are young girls, mostly in their reproductive ages who migrate from rural communities in the north to the commercial cities in the southern part of Ghana. During the last decade, out-migration of young girls to the commercial cities in Ghana to work as head porters has increased several fold creating streams of problems to both the migrants and the host population. In many ways the health implications on female porters have been overlooked, less explored and exacerbated by lack of policies to make the migration of female porters a healthy and socially productive process. The study focuses on the female porters who are working in the capital city of Ghana - Accra - without shelter and are exposed to rapists. The study finds that these porters usually trade in sex for shelter which exposes them to STDs including HIV/AIDS. The study also finds that knowledge about HIV among the respondents is very high yet they pay little attention to practising safe sex including the use of condom. In most cases, this results into unplanned pregnancies among many "kayayei", a majority of whom are unable to adequately cater for their babies and children.
Paper short abstract:
The feasibility of free public health policies in Niger - mainly thanks to the intervention of several NGOs - tends to favour the emergence of new temporal and geographical inequalities, especially with regard to access to maternal and child healthcare.
Paper long abstract:
In Niger, since 2006, it has been enshrined in law that maternal (namely prenatal) and child healthcare (for children under five years) are free of cost. However, in reality, this regime of free care derives more from the [Nigerien] state's concern with international pressures than from real health promotion for the population health's, especially for women and children. Indeed, since this regime of exemption was put in place state administration has never been able to ensure the allocation of funds which are necessary for its accomplishment. Consequently, at the local level, many health facilities must deal daily with budget problems which affect the quality of services provided to the population, particularly due to the constant lack of medicines and others consumables. In some areas where health facilities are supported by some NGO's - which help to bypass the financial difficulties, particularly through the donation of medicines or the hiring of health workers - the system of free maternal and child healthcare seems to work more effectively. Therefore, the transfer of funds through NGOs involved with the Nigerien health sector has contributed to the emergence of new forms of inequality both temporal (during the time in which health development projects are running) and geographic (not necessarily in the center versus periphery), especially with regard to women and children's access to health care. A case study highlighting these inequalities will be presented.
Paper short abstract:
Maternal mortality is a major public health issue in sub-Saharan Africa despite the improvement of medical technologies. This raises questions, namely the place of national policies, women’s living conditions and their access to the necessary medical care.
Paper long abstract:
Maternal mortality keeps being a major public health issue in sub-Saharan Africa despite the improvement of medical technologies and their dissemination. This raises questions at different levels : national policies set up to solve these problems as well as the plural reproductive experiences of women. This paper relies on research work carried out in Dakar. Its purpose is to identify and to understand the different logics such as social, cultural, health and gender factors among others, which contribute to building the situations of vulnerability Senegalese women are exposed to as regards the risk of maternal mortality. This paper analyses the different dynamics leading to the building of women’s reproductive paths, which expose them, to a greater or lesser extent, to the risk of maternal mortality. The question of the access to health structures and to the existing new technologies is at the heart of this problem which is particularly linked with poverty and raises ethical issues. This study focuses on different districts of Dakar and highlights the fact that in spite of the announcement by the state of a global improvement of maternal mortality, Senegal like other sub-Saharan African countries is still one of the most affected countries in terms of maternal mortality. This paper presents the results of the first phase of this study which brings out the combination of factors favoring situations of maternal mortality risk.
Paper short abstract:
This paper intends to show the rationale of a grassroots approach liable to reduce health inequalities related to malaria in rural areas and envision to see how and up to what extent such innovative medical action without professionals can be extended to African countries.
Paper long abstract:
Malaria is still prevailing in most Southeast Asian Regions, even if morbidity and mortality rates are much less than in Africa. In order to reduce health access inequalities and spatial discrepancies where no health structures are to be found, some countries like Cambodia (followed by Lao PDR and the Philippines) have initiated singular interventions in far-off areas. Some community health providers (called Village Malaria Workers: VMW) have been trained for providing malaria free diagnosis and treatment. The person is a local volunteer, the material used is a rapid diagnostic test and the medication consists in an artemisinin combination therapy. Such triple standardization, reinforced by a geographical homogenization process, aims to reduce health inequalities. Everyone has access to this 'home service', especially children, pregnant ladies and young mothers who are particularly biologically and socially vulnerable to the infection. Such a national policy which gave birth to the existence of a few thousands of volunteers scattered in the remaining malaria endemic areas relies on the improvement of the provision of treatment where there is no doctor. Additionally, this grassroots facility enables people to have a prompt access, in case they prefer not to rely on public health services. The oral presentation will analyze up to what extent the adoption of this strategy is variably incorporated in people's health perception and practices. Further discussions after the presentation are expected to foresee up to what extent some African countries could take a similar code of conduct into consideration in malaria remote areas.
Paper short abstract:
Infertile sub-saharan women travel to other African countries and to Europe in order to have access to assisted reproductive technologies (ART). This mobility across national and international borders has taken place in Sub-Africa since the 1990s.
Paper long abstract:
The lives of infertile Sub-African women are generally depicted as marked by suffering and exclusion. They feel a pressure from their family and other relatives, especially women. Infertile sub-saharan women travel to other African countries or to Europe in order to have access to assisted reproductive technologies. These women have to cope with the cost of the treatment, travel and health services. How do they choose the country, the health service, and the physician? Are the choices individual or undertaken by couples ? Where do they find the money for this?
This paper uses the language of "scapes" to examine the global flows involved in the so-called search for assisted reproductive technologies across national and international borders. Reproductive mobility entails a complex "reproscape" (Inhorn, 2011) of moving people, technologies, finance, media, ideas, and gametes, pursued by infertile couples in their "quests for conception." We will examine reproductive mobility to and from sub-saharan African countries, which are the site of intense globalization and global flows, including individual movements for the purposes of assisted reproduction technology since the 1980s.
Paper short abstract:
Angola is one of the priority countries of the "Global Plan towards the Elimination of new HIV infections among Children by 2015". Latest data suggest PMTCT coverage is weak and the progress towards the goals of the Global Plan may be compromised.
Paper long abstract:
Despite having an estimated HIV prevalence in adults of 2.1% [1.5%-3.2%], which is much lower than its neighbours Zambia (12.5%) and Namibia (13.4%), Angola was ranked among the twenty two countries with the highest estimated number of pregnant women living with HIV. Ten years after the end of the civil war, Angola still has a weak health structure and strong inequalities regarding access to health care, particularly to HIV treatment. Since the adoption of the PACTG 076 protocol in 2004, the creation of Prevention of Mother-To-Child Transmission (PMTCT) services was remarkable and the number of women accessing antenatal care has increased in the last six years. However, PMTCT programme coverage is still very limited, with only 16% of pregnant women living with HIV and 17% of children born to HIV-positive mothers receiving antiretrovirals for PMTCT. As a result, latest data from UNAIDS suggest that the number of new HIV infections among children may have increased in Angola in 2011, which may compromise the attainment of the "Global Plan towards the Elimination of new HIV infections among Children by 2015 and keeping their Mothers Alive" as well as the Millennium Development Goals. Strong efforts to scale up PMTCT services and improve access of women and their children to effective treatment will need to be made.
Paper short abstract:
To ensure that women who have given birth in health facilities are screened two strategies are implemented: The opt in and the opt out. The presentation aims at questioning these two strategies regarding the challenge of access to health care.
Paper long abstract:
The prevention of mother-to-child transmission remains a challenge for the health system in sub-Saharan Africa since the success of this program requires attendance at the structures of care by women during their pregnancy. In Cameroon, the North and far North regions are distinguished by low attendance at prenatal care by pregnant women. To get around this problem and to ensure that women who have given birth in health facilities have been screened the Ministry of public health has implemented two strategies for women whose HIV status is not known at the time of their birth. These strategies are applicable only in the delivery room. The opt in strategy refers to making an HIV screening in the delivery room after a written or an oral consent of the patient. Whereas the opt out strategy relies on an « implicit consent » of the labouring woman in the delivery room with the assumption that other biological screening such as complete blood counts, hepatitis serology, etc. are generally required.
This presentation aims at questioning these two strategies regarding the challenge of access to health care. This work is based on preliminary results of an ethnographic survey conducted from august to September 2012 in the North and the Far-North region. It is divided into two principal parts: firstly, the context of the implementation of these two strategies and secondly the ethical and deontological justification of caregivers as well as their practices.