Safe motherhood initiative: From control to trust Anthropological analysis of risk in Mali (West Africa)

Objectives. -This article addresses risk management in maternal health in Mali. Risk concept is used as a tracer to investigate uncertainties and their answers at the different levels of maternal health. Representations and practices related to risk are analyzed through concept of trust and uncertainties linked to the maternal health system reform. Methods. -We investigated the conceptions and practices related to risks, changes and uncertainties through qualitative investigations and analyses, taking into account different levels of health reforms (policy-makers, regional managers, practitioners, consumers). Forty-nine qualitative and semi-structured interviews were carried out in urban, semi-urban and rural environment in Mali. Results. - In order to reach a better management of risk in maternal health, through action coordination, it is necessary to analyzed real, observed and perceived risks through its different meanings. Depending on representations, risk is seen as measurable data or uncertainty; all revealing specific approaches of unpredictable event. Conclusion. -Safe motherhood call for a better control on danger associated to pregnancy and birth. Such control is allowed by the elaboration of a relation of trust between population and its health system. (c) 2007 Elsevier Masson SAS. Tous droits reserves.