The social life of reproductive health commodities in Ouagadougou, Burkina Faso: an ethnographic study

Abstract

In recent years, there has been a growing focus on essential reproductive health commodities, including drugs and supplies for safe motherhood, contraceptives to control fertility and drugs like misoprostol, which has been hailed as a revolution for maternal health globally because of its potential to reduce pregnancy-related mortality and morbidity and to provide relatively safe termination or pregnancy. In contrast to public health approaches that frame such commodities as technological means to achieve demographic and maternal health outcomes, this thesis draws medical anthropology and science and technology studies to explore how reproductive health commodities acquire different meanings and purposes as they circulate in society. The thesis is based on ethnographic fieldwork conducted in Burkina Faso, a low-income country in West Africa where contraceptives and misoprostol play important roles in efforts to address very high fertility and mortality resulting from unsafe abortion. The fieldwork included participant observation, in-depth interviews with women of reproductive age, healthcare workers and informal drug vendors, and review of documents about national and international reproductive health governance. Across three published papers, the thesis analyses the ‘social life’ of contraceptives at the intersection of formal and informal systems of reproductive health care, showing that healthcare workers and street drug vendors engage in ‘pharmaceutical diversion’ in disseminating misoprostol and knowledge about it to networks of individuals outside of the drug’s formal, regulated circuits. Meanwhile, women ‘domesticate’ reproductive health commodities to create new uses for them whether using misoprostol as an emergency contraceptive or to induce abortion clandestinely, or using hormonal contraceptives to achieve social, romantic, or bodily aesthetic goals. Though reproductive health commodities help women exercise agency over reproduction, negotiating access to them also exposes women to violence and creates new forms of inequalities.