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Date Submitted

Spring 4-16-2015

Research Mentor and Department

Carolyn Sargent

Restricted/Unrestricted

Dissertation/Thesis

Abstract

In rural Madagascar, women seeking reproductive health care may have the option of consulting their traditional birth attendant, local midwife or biomedical physician. In those cases in which a woman does have a choice, our understandings of how she makes that decision is limited. In my research, I investigate women’s perspectives on the health care options available to them and seek to understand the factors that influence their decision to choose a particular type of care. I seek not to validate biomedical care and critique traditional practices; rather, I seek to understand the interplay between cultural traditions and the health care system, as well as the barriers, whether physical, cultural, or spiritual, that women may face in seeking their preferred type of care.

I traveled to Mahabo, Madagascar in May 2014 and conducted 23 interviews with women in the community as well as doctors, midwives, traditional birth attendants, and local leaders. My research reveals that women in Mahabo-Mananivo seek a combination of type of reproductive care: they value the clinic and attend free monthly prenatal appointments, but primarily deliver their children at home due to significant financial, physical and spiritual barriers. Through the lens of the socio-ecological model, I suggest several means to improving childbirth outcomes in this community from a culturally informed perspective: 1) teaching hygiene practices, 2) increasing engagement and building trust between community members and the doctor, 3) improving transportation and accessibility with an ATV, 4) community outreach through skits and dialogue, and 5) building a midwifery clinic to bridge the gap between the community and biomedicine.