Société et développement

Les monographies des anthropologues s’attardent parfois sur la négociation de leur place sur leur “terrain”, sur les questions méthodologiques, épistémologiques et / ou éthiques qui se sont posées durant le déroulement de la recherche. Toutefois, aucun ouvrage n’avait, jusqu’à présent, disséqué avec autant de précisions et d’honnêteté intellectuelle, la « fabrique » de l’anthropologie. Laurent Vidal s’est attelé à cette tâche avec cet ouvrage dans lequel tous les chercheurs, travaillant dans le champ de l’anthropologie de la santé ou celui du développement, reconnaitront les vicissitudes qu’ils ont rencontrées lors de la mise en place de leurs dispositifs de recherche.

Boundary work refers to the strategies deployed by professionals in the arenas of the public, the law and the workplace to define and defend jurisdictional authority. Little attention has been directed to the role of documents in negotiating professional claims. While boundary work over induced abortion has been extensively documented, few studies have examined jurisdictional disputes over the treatment of abortion complications, or post-abortion care (PAC). This study explores how medical providers deploy medical records in boundary work over the treatment of complications of spontaneous and induced abortion in Senegal, where induced abortion is prohibited under any circumstance. Findings are based on an institutional ethnography of Senegal’s national PAC program over a period of 13 months between 2010 and 2011. Data collection methods included in-depth interviews with 36 health care professionals, observation of PAC services at three hospitals, a review of abortion records at each hospital, and a case review of illegal abortions prosecuted by the state. Findings show that health providers produce a particular account of the type of abortion treated through a series of practices such as the patient interview and the clinical exam. Providers obscure induced abortion in medical documents in three ways: the use of terminology that does not differentiate between induced and spontaneous abortion in PAC registers, the omission of data on the type of abortion altogether in PAC registers, and reporting the total number but not the type of abortions treated in hospital data transmitted to state health authorities. The obscuration of suspected induced abortion in the record permits providers to circumvent police inquiry at the hospital. PAC has been implemented in approximately 50 countries worldwide. This study demonstrates the need for additional research on how medical professionals negotiate conflicting medical and legal obligations in the daily practice of treating abortion complications.

Ebola n’est pas la seule maladie infectieuse à toucher l’Afrique. La persistance d’autres épidémies témoigne d'une situation sanitaire critique. L’anthropologue Yannick Jaffré revient sur les faiblesses structurelles qui minent le continent.
Les dernières données épidémiologiques font état de 14 000 cas plus ou moins confirmés et de 5 000 décès dus au virus Ebola. Comment ne pas être touché par l’extrême solitude des malades et par l’éthique absolue de ceux qui les soignent ou tentent de prévenir la propagation du virus ? Le respect s’impose. Derrière ces aspects immédiats, et particulièrement dramatiques, Ebola pose également des questions de fond, directement liées aux sciences sociales et à la façon dont celles-ci abordent les épidémies : les contextes sociétaux dans lesquels ces maladies infectieuses se développent, la qualité des interactions entre les services de santé et les populations, le choix des politiques de santé ou, encore, les modalités d’application de ces politiques.

Abstract : The “rightness” of a technology for completing a particular task is negotiated by medical professionals, patients, state institutions, manufacturing companies, and non-governmental organizations. This paper shows how certain technologies may challenge the meaning of the “job” they are designed to accomplish. Manual vacuum aspiration (MVA) is a syringe device for uterine evacuation that can be used to treat complications of incomplete abortion, known as post-abortion care (PAC), or to terminate pregnancy. I explore how negotiations over the rightness of MVA as well as PAC unfold at the intersection of national and global reproductive politics during the daily treatment of abortion complications at three hospitals in Senegal, where PAC is permitted but induced abortion is legally prohibited. Although state health authorities have championed MVA as the “preferred” PAC technology, the primary donor for PAC, the United States Agency for International Development, does not support the purchase of abortifacient technologies. I conducted an ethnography of Senegal's PAC program between 2010 and 2011. Data collection methods included interviews with 49 health professionals, observation of PAC treatment and review of abortion records at three hospitals, and a review of transnational literature on MVA and PAC. While MVA was the most frequently employed form of uterine evacuation in hospitals, concerns about off-label MVA practices contributed to the persistence of less effective methods such as dilation and curettage (D&C) and digital curettage. Anxieties about MVA's capacity to induce abortion have con- strained its integration into routine obstetric care. This capacity also raises questions about what the “job,” PAC, represents in Senegalese hospitals. The prioritization of MVA's security over women's access to the preferred technology reinforces gendered inequalities in health care. 
Despite impressive global investment in reproductive health programs in West Africa, maternal mortality remains unacceptably high and obstetric care is often inadequate. Fertility is among the highest in the world, while contraceptive prevalence remains among the lowest. This paper explores the social and technical dimensions of this situation. We argue that effective reproductive health programs require analyzing the interfaces between technical programs and the social logics and behaviors of health professionals and client populations. Significant gaps between health programs’ goals and the behaviors of patients and health care professionals have been observed. While public health projects aim to manage reproduction, sexuality, fertility, and professional practices are regulated socially. Such projects may target technical practices, but access to care is greatly influenced by social norms and ethics. This paper shows how an empirical anthropology that investigates the social and technical interfaces of reproduction can contribute to improved global health.