After receiving a Master of Public Health in 2004, I worked in Senegal for several years with Management Sciences for Health (MSH), a global health NGO contracted by US Agency for International Development (USAID) to support the national Ministry of Health in improving maternal and child health. MSH conducted training and supervision activities related to treating complications of incomplete abortion, also known as post-abortion care or PAC. During these activities, we spoke with health workers about treating obstetric complications, but never about the kinds of abortions being treated, or the likelihood that part of their clinical caseload might be related to illegally-terminated pregnancy. The silence around abortion in Senegal’s PAC program illustrated with striking clarity, nearly thirty years later, the lingering geopolitical effects of the infamous 1984 Mexico City Policy (also known as the Global Gag Rule), and how anti-abortion development aid actively jeopardized the quality of reproductive health care in West Africa.
In 2010, I returned to Senegal as a doctoral student to investigate what I could not while working with a USAID-funded NGO: what does it mean to practice and evaluate the impact of PAC in a country where induced abortion is illegal and the US has been the most generous donor of population aid since the early 1980s? These questions about how obstetric care is situated in global systems of reproductive governance continue to motivate not only my research and teaching, but also my commitment to reproductive justice.
My book, “Dying to Count: Post-Abortion Care and Global Reproductive Health Politics in Senegal,” explores how national and global population politics collide in Senegalese hospitals as health workers treat and document women who present with complications of abortion. Based on direct observation of PAC services and records, my ethnography illustrates political, economic, professional, and technological factors that jeopardize quality of and access to obstetric care in public hospitals despite national and global commitments to reproductive health.
Manual Vacuum Aspiration (MVA) Kit in a district hospital in Senegal
My current project, titled “Into Women’s Hands: Misoprostol and the Politics of Reproduction in Burkina Faso and Senegal,” is a global South-North research collective with funding from the Hewlett Foundation. This project explores how a pill that promises to reduce maternal mortality by placing obstetric care directly “into women’s hands” simultaneously opens and forecloses possibilities for reproductive justice in Burkina Faso and Senegal. I am collaborating with Professor Nathalie Sawadogo at Université Joseph Ki-Zerbo and Professor Tidiane Ndoye at Université Cheikh Anta Diop to conduct qualitative, women-centered research on the availability, distribution, and use of misoprostol for approved and off-label obstetric indications in formal and informal health sectors in the two countries. Additionally, we will pilot a training program in ethnographic health research for graduate students at Université Joseph Ki-Zerbo and Université Cheikh Anta Diop.
Misoclear: A brand of misoprostol available in Francophone Africa
Photo Courtesy: https://pulitzerfieldnotes.tumblr.com/post/60269629438/scratch-and-live-around-lagos-the-outer-walls