Pierre Bourdieu and transformative agency: a study of how patients in Benin negotiate blame and accountability in the context of severe obstetric events

Abstract

This paper explores the social and institutional processes that constrain and enable obstetric patients in Benin to critically evaluate quality of healthcare and to stimulate positive changes in the health system. Based on qualitative data collected as part of a hospital auditing system, the paper analyses semi-structured patient feedback interviews and their function as a primary mechanism through which critical patient evaluation can develop constructively. Using a Bourdieuan framework, we explore the dynamic social conditions that give rise to transformative agency and institutional change. Our results show that hospitals are often permeated with the habitus of employment, kinship and reproductive social fields, through which a number of social, economic and healthcare conflicts, power struggles and blame-inducing interactions emerge. These conflicts generally serve to keep patients quiescent and passive when it comes to developing critical statements of quality of care. In a subset of cases, however, these conflicts are transformed by patients and their family members into opportunities for modifying the values and practices of each habitus in new and creative ways. The active negotiation of social conflict and blame enabled a minority of patients actively to divert blame from themselves and to develop and maintain critical healthcare evaluations.

The role of delays in severe maternal morbidity and mortality: expanding the conceptual framework

“…18,24,25 Given that decision-making is a complex behaviour related to perception of needs, which is dependent on the interaction between individual traits, characteristics and the exposure to social, cultural, and economic conditions, gathering information requires a broad approach. 19,26 For instance, the use of antenatal care seems to enhance the utilization of emergency obstetric care, the same way that lack of antenatal access is associated with delays leading to poor maternal outcomes. 27 Given the complexity of health needs, Rodríguez Villamizar and colleagues 28 added an additional delay for doing maternal mortality surveillance.…”

Balancing authority, deference and trust across the public–private divide in health care: Tuberculosis health visitors in western Maharashtra, India

“…As hidden links in the PPM-DOTS chain, TB HVs need formal acknowledgement, supportive supervision and the opportunity to acquire new skills. If officially recognised and respected as ‘partners’, TB HVs might take on more active roles in identifying commonly recurring problems, initiating change processes and evaluating improvements in the programme (Béhague, Kanhonou, Filippi, Lègonou, & Ronsman, 2008; Dieleman, Gerretsen, & Jan van der Wilt, 2009). This is especially relevant given their proximity and close attention to the multiple layers and forms of accountability in the PPM-DOTS.…”

Anthropological Insights about a Tool for Improving Quality of Obstetric Care: The Experience of Case Review Audits in Burkina Faso

“…To develop more patient-centred approaches, an objective of interviews was to emphasize individual and socio-economic constraints in addition to medical issues. A similar approach has also been att empted in Benin, but with interviews taking place in hospital rather than at home (Béhague et al 2008). Béhague and colleagues report the impact of women's opportunity to talk: [R]esults show that the audit feedback interviews gave some women … the opportunity to actively redress social confl icts and injustices imbedded in their health-care experiences ….…”