[Is the fight against maternal mortality in Burkina Faso adapted to reduce the three delays?]

Optimizing primary health care in Burkina Faso: an approach informed by EQUIST

Introduction

Burkina Faso has made access to primary health care a national priority by including it in the 2021-2030 national health development plan.

Purpose of research

Our study aimed to analyze the causes of inequalities in access to primary health care, priority interventions and strategies for strengthening primary health care, and their potential impact on reducing maternal and infant mortality.

Results

Diarrheal diseases, malaria, and pneumonia are the main causes of inequalities in infant and child deaths in rural areas. As for maternal deaths, abortion and its complications are the main causes of inequalities in deaths associated with hypertensive disorders. The Sahel, Boucle du Mouhoun, Center-North, East, and Cascades regions are the geographical areas where interventions are essential to reduce inequalities in maternal, neonatal, infant and child deaths and malnutrition.

Conclusions

The national priorities have included all the high-impact interventions for strengthening primary health care identified in our study. Interventions must prioritize the populations in rural areas, the most affected and high-impact geographical regions. This requires the involvement and empowerment of beneficiary communities and the consideration of the fragile safety context.

Maternal mortality study in the Eastern Democratic Republic of the Congo

Background

The reduction of maternal mortality in developing countries such as the Democratic Republic of Congo (DRC) still raises many questions. Indeed, this large country in the heart of Africa ranks 4th among the eight countries that alone account for more than 50% of maternal deaths in the world, behind India, Nigeria and Pakistan. However, there is no up-to-date data on maternal mortality in eastern DRC. This study measures the mortality rate rate in health facilities in eastern DRC and identifies the associated risk factors.

Methods

This analytical epidemiological study was based on retrospective data materna deaths recorded in 59 health facilities, in three health zones in the southern part of Maniema province in east DRC. The study was conducted from July 1, 2015 to June 30, 2020. Descriptive, bi and multivariate analyses were used.

Results

The maternal mortality rate was estimated at 620 deaths per 100,000 live births, of which 46% of maternal deaths were related to a parturients’ delayed decision in seeking healthcare in time (first delay). Maternal deaths were significantly associated with extreme ages (≤ 19 years and ≥ 40 years: p =  < 0.001), patient parity (in primigravidas and in large multiparas: p = 0.001), complications such as hemorrhagic, (p =  < 0.001), uterine ruptures:(p =  < 0.001), infections, (p =  < 0.001), and dystocia (p =  < 0.001).

Conclusion

Despite the efforts made by the DRC and its partners in the fight against maternal mortality, women continue to lose their lives when they decide to give birth. The results imply that it is imperative to strengthen both women and health professionals’ knowledge about pregnancy and maternal health and their power to reduce instances of first delay by supporting women in formulating their birth plans.

"I wasn't ready": abortion decision-making pathways in Ouagadougou, Burkina Faso

Objectives

This study explores abortion decision-making trajectories in Ouagadougou, Burkina Faso, examining the spaces for decision making that young people manage to create for themselves within restrictive policy, gender norms and other constraints.

Methods

The study presents data collected from observations in three referral health facilities in Ouagadougou and interviews (with 31 young women (aged 17–25) who had sought abortions and five men (aged 20–25) whose partners had done so). Using inductive content analysis, we capture the different streams, actors and rationales in the decision-making process, as well as the pattern of negotiation.

Results

Abortion decision-making trajectories are complex and affected by a range of factors including fertility desires, relationship stability and financial stability. The process can include intense periods of negotiation between intimate partners when their rationales are discordant. Constraints on women’s decision making include restrictive policy environment, coercion from partners (threats, emotional blackmail and even physical force) and pressure from people in and out of their social network.

Conclusions

In a context where legal abortion is highly restricted and women’s decision-making power is constrained, the abortion decision making appears as collective, operates in an uncertain time frame, an unofficial social environment and has an unpredictable collaborative mechanism.