In sickness and in health: Responding to disease and promoting health in Senegal.

摘要

This study examines rural and urban women's knowledge and practice within the context of two decades of health sector reform in Senegal. It addresses the simultaneous influence of macro-level forces, such as international policy and national health reform, and micro-level social, economic, and political realities on women's lives. Within this comparative study of women's knowledge and practice, I am primarily interested in how knowledge frameworks facilitate different health strategies. I see women's health behavior as the outcome of knowledge encounters between Islam, biomedicine, and Wolof medicine that is itself suffused with dimensions of Islamic practice. Knowledge is both relational and situated, meaning that women's understandings of health are shaped by their social location within households and family structures, by their education (or lack thereof), their age, and their class position.; Over the past two decades the Senegalese Ministry of Health has implemented a number of reforms designed to reduce government spending on health care. In the dissertation I explore the effects of privatization, decentralization, and community management of health structures on state employees within the Ministry of Health and on the general population. The medical district of Saint Louis provides a case study of the current situation; I focus on the district administrators and medical personnel, and women in two related communities within the district's coverage zone, the rural village of Darou-Mboumbaye and the urban neighborhood of Pikine.; This context of health sector reform is the backdrop against which I explore how gender relations and gender ideologies mediate the effects of socioeconomic and political change, and how they influence women's abilities to mobilize around health issues. In order to explore the obstacles that women face as they try to resolve health care problems, I analyze how women are situated within overlapping arenas of power and influence in the domestic and public spheres. These arenas of power include the household and family, the village, the neighborhood of Pikine, and the city of Saint Louis. Women's political marginality in rural and urban areas, their limited earning potential, and the cultural and religious imperative for them to defer to patriarchal authority figures limits their ability to resolve health issues. In spite of these obstacles, women actively seek solutions for their own health problems as well as those of children and other family members.