Why maternal mortality decreases so slowly in Africa despite the improvement of health care services? Is it due to cultural factors or an inadequate sanitary organization? The experience of the rural population of Bandafassi in Senegal.

Malick Kante, Institut National d'Études Démographiques (INED)
Emmanuelle Guyavarch, Institut National d'Études Démographiques (INED)
Gilles Pison, Institut National d'Études Démographiques (INED)

In Africa, more than elsewhere, health care services remain insufficient. Construction of new medical infrastructures and improvement of health programs are a priority especially in rural areas. Are they sufficient to improve health when modern sanitary equipments are opened in non-equipped areas? Until now, in some zones, those evolutions haven’t had any impact on the health indicators improvement. The “cultural brake” is often given as an explanation to this slowness because it would prevent the modernity diffusion. But are “Culture” and its brakes the only explanations? To illustrate this questioning, the case of an ultra-modern hospital construction in a rural and non-equipped area of Senegal is presented. The demographic surveillance site of Bandafassi is in the south-east of Senegal, about 750 km from the capital. On March 31, 2007, the followed population is 12,079 inhabitants. In 2002, medical services in this region were transformed by the opening of a private hospital, the Ninefescha’s hospital. Its main goal is to reduce the maternal and infant mortality of the zone. But, the analysis of demographic surveillance data to estimate mortality trends from the early 1970s until 2006, reveals that this hospital hasn’t decreased the mortality. To explain the reasons of this insufficient impact, we have realised in 2007 a specific survey on the health seeking behaviours during pregnancy and delivery and during childhood (from a representative sample of 300 women who had a baby during the last 12 months and 1,000 children under 5 years of age). This communication analyses only the health behaviours of pregnant women and its variations according to characteristics (age, education, religion, marital status, ethnic group, distance of the hospital). Lessons will be drawn from the Bandafassi experience so as to improve the efficiency of health infrastructures in poorly-equipped rural areas of Sub-Saharan Africa.