Locating the Informal in the Formal?
This paper explores the influences that led to the development of the Free Health Care
Initiative (FHCI), which requires the provision of free health services for pregnant
women, lactating mothers, and children under the age of five years. The paper will
explore the impact of the policy on women actors as both recipients and informal
providers of health care in post-war Sierra Leone. Since the end of the Sierra Leone
civil war in 2002, there has been much focus on maternal and child health issues due
to the staggeringly high maternal and child mortality rates, when compared to the
rest of the world. Currently, international considerations exist such as the Convention
for the Elimination of All Forms of Discrimination Against Women (CEDAW) and the
Millennium Development Goals (MDGs) to ensure nations are responsive to women’s
health concerns. These often externally driven policies may not be based on internal
motivation, and may have negative local consequences.
Although the FHCI has improved accessibility of clinical services provided by the
government by eliminating user fees, a provision was made to eliminate the services of
traditional birth attendants (TBAs), who historically provided affordable birth services
for women in rural regions of Sierra Leone. The new health policy thus criminalizes
the actions of TBAs, stripping them of the ability to practice their craft and earn a
living. This paper examines the sometimes-contradictory results inherent when international
laws and mandates get translated into local contexts and problematizes the
uni-dimensional ways in which women’s empowerment is often promoted.