The Human Factor Social sciences in global health research.

ITM Colloquium 2014 - Antwerp

Unpredictable children.

Local meanings and uses of family planning in a refugee camp, South Sudan

Umberto Pellecchia - Médecins Sans Frontières, MSF- Brussels

Presentation for Theme 2

SOCIAL SCIENCES CONTRIBUTIONS TO GLOBAL HEALTH RESEARCH

THE CONTEXT

Doro Refugee Camp, South Sudan

THE CONTEXT

Doro Refugee Camp, South Sudan

→ Result of the (ongoing) conflict in Blue Nile (2010-2011)

→ Different waves of refugees, currently 48,000 ca.

→ Mixed ethnic composition: mainly Uduk and Ingassana

→ Various INGOs for food, WASH, NFIs, medical care

→ Medical care provided by MSF – OCB: OPD, IPD, Maternity, Malnutrition

→ Main morbidities: Malaria, Malnutrition, Diarrhoea, Hepatitis E

→ Unstable context: ongoing conflicts (Nuer vs Dinka)

→ Village-like camp: tents are mixed with semi-stable tukuls (adobes)

→ Camp divided into “villages” (10+)

THE METHODOLOGY

Ethnographic Research

3 months fieldwork

Participant observation in 5 different villages - Social life (weddings; celebrations; daily activities)

- Family discussions - Local healing practices (incl. TBAs)

Participant observation in MSF Health Facilities / Activities - IPD and Maternity Department + Ambulatories for Treatments of Malnutrition

- Health Promotion and Psyco-Social Activities

60 Semi-structured (qualitative) interviews - Groups of men and women (different age sets)

4 Focus Group Discussion (initial phase)

Comparative literature review

THE RESEARCH QUESTIONS

Based upon:

- high risk related to pregnancies

- volatile food availability in the camp

- concerns related to high number of children / woman

→ ACCEPTANCE OF FAMILY PLANNING PROGRAM?

→ EXISTING LOCAL PRACTICES?

→ HOW IS REPRODUCTIVE HEALTH LOCALLY PERCEIVED?

THE THEORETICAL APPROACH

MEDICAL ANTHROPOLOGY

Concepts of body, birth, feritlity, fecundity, care

ANTHROPOLOGY OF PARENTHOOD

Concepts of family, identity, power relationships, descent, ancestry

ANTHROPOLOGY OF RISK

Risk, fear, security / insecurity

FAMILY PLANNING: SOCIO-CULTURAL FEATURES

Has FAMILY universally the same features?

Which idea of FAMILY stands behind a family planning medically addressed?

Pics Credits: http://www.who.int/topics/family_planning/en/

FAMILY PLANNING: SOCIO-CULTURAL FEATURES

Uduk are matrilineal – Management of fertility includes non strictly biological partners

FAMILY PLANNING: SOCIO-CULTURAL FEATURES

Bride price and descendants expectation

Ingassana: groom’s family pays in goods and services for the bride.

Bride is expected to produce descendants

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FAMILY PLANNING: SOCIO-CULTURAL FEATURES

→ Concept of social body

“[…] certainly I want to space children enough to breastfeed them, but who am I, who am I, to decide how many children I’d have? […]”

→ Supernatural implications

“[…] when a woman gets pregnant means that a good spirit has blessed her […] and this spirit must be worshipped […] and this is also the reason why she has to be careful in the

evil eye”

“Q. How many kids you’d like to have?

A. As many as God gives me.”

(all quotes from interviews, 2014)

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FAMILY PLANNING: SOCIO-POLITICAL FACTORS

Gender relationships - male dominated setting

Very unstable setting - conflicts

Scarce food availability - dependency from WFP

Absence of formal income - no land

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FAMILY PLANNING: SOCIO-POLITICAL FACTORS

Compelled reliance on Organization’s food distribution

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UNPREDICTABLE CHILDREN

Family is conceived otherwise

Number of children set by non necessarily biological parents

Birth control is social

—-

Socio-political forces shape the family decision

Timing is not necessarily a matter of individual / collective choice

Perception of risk influences pregnancy decisions

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UNPREDICTABLE CHILDREN: Conclusions

Family Planning is perceived as a way to cope with unstable period aimed at having many children as possible*

Contraceptive use is functional to management of crisis period where it could be perilous to have children (preference for Depo-Provera)

Cfr. C. Bledsoe Contingent Lives. Fertility, Time, Age in Wiest Africa, 2002, University of Chicago Press

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UNPREDICTABLE CHILDREN?

Should a medical program as FP proposed to a population that would use it to cope with social distress?

The “individual” consent - woman-centered - to FP is effective in a socially shaped family culture?

Should the question of number of children (birth control) be at the core of a FP program when the desired number exceeds the Western expectations?*

Isn’t Primary Health Care / Access to Health and Maternity a better orientation for a health program in economically disenfranchised countries?

Cfr. Lock M., Vinh-Kim H., The Anthropology of Biomedicine, 2010, Wiley- Blackwell