Fear, guilt, and debt: an exploration of women’s experience and perception of cesarean birth in Burkina Faso, West Africa

Abstract

Fabienne Richard,1 Sylvie Zongo,2 Fatoumata Ouattara31Maternal and Reproductive Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium; 2Institut de Recherche pour le Développement, Burkina Faso, West Africa; 3Institut de Recherche pour le Développement UMR912, "Sciences Economiques et Sociales de la Santé et Traitement de l’Information Médicale - SESSTIM", Marseille, FranceBackground: This paper explores women’s experience and perception of cesarean birth in Burkina Faso and its social and economic implications within the household.Methods: Five focus groups comprising mothers or pregnant women were conducted among residents of Bogodogo Health District in Ouagadougou to assess the perceptions of cesarean section (CS) by women in the community. In addition, 35 individual semistructured interviews were held at the homes of women who had just undergone CS in the referral hospital, and were conducted by an anthropologist and a midwife.Results: Home visits to women with CS identified common fears about the procedure, such as "once you have had a CS, you will always have to deliver by CS". The central and recurring theme in the interviews was communication between patients and care providers, ie, women were often not informed of the imminence of CS in the delivery room. Information given by health care professionals was often either not explicit enough or not understood. The women received insufficient information about postoperative personal hygiene, diet, resumption of sexual activity, and contraception. Overall, analysis of the experiences of women who had undergone CS highlighted feelings of guilt in the aftermath of CS. Other concerns included the feeling of not being a "good mother" who can give birth normally, alongside concerns about needing a CS in future pregnancies, the high costs that this might incur for their households, general fatigue, and possible medical complications after surgery.Conclusion: Poor quality of care and the economic burden of CS place women in a multifaceted situation of vulnerability within the family. CS has a medical, emotional, social, and economic impact on poor African women that cannot be ignored. Managers of maternal health programs need to understand women’s perceptions of CS so as to overcome existing barriers to this life-saving procedure.Keywords: cesarean section, quality of care, access to care, anthropology