What happens during antenatal visits? An ethnographic study of pregnant women’s experiences with midwives in Benin

ABSTRACT

Pregnancy and childbirth place women at risk of morbidity and mortality, particularly in Benin where the health system is fragile. This study aimed to understand women’s experiences concerning their interactions with midwives during antenatal visits and to explore contextual factors influencing these interactions and the quality of care received. A qualitative study was conducted from June to August 2015 in two primary health facilities in So-Ava, Benin. One hundred seven individual in-depth interviews with 100 pregnant women, five midwives, and two physicians and one focus group discussion with seven government decision-makers were conducted. Despite midwives’ good intentions, most pregnant women reported absenteeism, delays, cold attitudes, fear-based communication, and arbitrary and non-consensual interventions during antenatal visits and believed midwives would interfere with their family relationships. The suboptimal quality of care provided by midwives was interpreted as due to several factors, including lack of accountability of midwives in health facilities. The communication of midwives with pregnant women needs improvement. Results of this study highlight the importance of understanding the problem from the perspective of the political economy of the Benin health system to address its structural and systemic failures with open dialogue, including implementation of accountability measures.

KEYWORDS:

• Pregnant women
• midwives
• antenatal visits
• accountability
• quality of care
• Benin

Acknowledgments

The authors would like to thank Dean Harvey Skinner (York University) and Professor Mary Wiktorowicz for providing financial support for the study. We would like to thank Professor Mary Wiktorowicz for contributing to the development of this project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

This study was authorized by York University’s Research Ethics Committee, municipal representatives in So-Ava, and elders in local communities prior to data collection (Ethics approval Certificate #: e2015 – 171).

Additional information

Funding

The study is funded by York Incentive Grant and the Faculty of Health (York University).