What midwives have to say about their lives, their jobs and their healthcare practices

Introduction: This paper is based on two observations. First, despite multiple health programmes, access to services and quality of obstetric care remain inadequate in Africa. Secondly, although several qualitative studies have described the poor quality of admission facilities, violence during delivery and neglect of the poorest women, the reasons behind these behaviours have not been elucidated. This survey, conducted in Benin and Burkina Faso, examined midwives' experiences of their job, their obstetric practices and their lives. By including the emotional, sensorial, linguistic and social elements, this paper shows important discordances between the proposals made by programmes (installation in rural areas, strict financial management) and midwives' social and emotional duties and economic roles. It highlights the importance of gender relations in the careers of these professionals. The study also shows that the attitudes of midwives are related to the fact that childbirth is considered to be a moral act and their mistreatment behaviour corresponds to constant shifts between technical skills (fertility) and value judgements concerning expression of pain, sexuality and desire. On the other hand, midwives justify their violent practices by the urgency of the situation, especially during childbirth. The provision of care and effective implementation of programmes cannot be improved without taking into account these forms of justification and without constructing dialogues enabling midwives to develop a reflection about their social and emotional constraints, their relation to sexuality, and the reasons for their actions.