The anti-politics of health reform: household power relations and child health in rural Senegal

Abstract

This article employs ethnographic evidence from rural Senegal to explore two dimensions of health sector reform. First, it makes the case that health reforms intersect with and exacerbate existing social, political, and economic inequalities. Current equity analysis draws attention to the ways that liberal and utilitarian frameworks for health reform fail to achieve distributive justice. The author's data suggest that horizontal power relations within households and small communities are equally important for understanding health disparities and the effects of health reform. Second, the article explores how liberal discourses of health reform, particularly calls for ‘state–citizen partnerships’ and ‘responsiblization’, promote depoliticised understandings of health. Discourses associated with health reform paradoxically highlight individual responsibility for health while masking the ways that individual health practice is constrained by structural inequalities.

Keywords:

• health reform
• neoliberalism
• Senegal

Acknowledgements

The author would like to thank Suzanne Schneider and the anonymous reviewers for their helpful suggestions. The research for this article was assisted by funds from the US Department of Education Fulbright-Hays Doctoral Dissertation Abroad Fellowship; a fellowship from the International Dissertation Field Research Fellowship Program of the Social Science Research Council with funds provided by the Andrew W. Mellon Foundation; and a National Science Foundation dissertation enhancement award. All research was carried out with the approval of the Institutional Review Board of Michigan State University; all research participants gave their informed consent before speaking with the author.

Notes

Notes

1. At least 40% of marital unions in Senegal are polygynous, and this percentage is higher in rural areas (Senegal DHS 2005).