Exploring the connectedness of rural auxiliary midwives to social networks in Koutiala, Mali

Abstract

Background: rural auxiliary midwives are central to clinical maternal care in Mali. However, little is known about their social role within the villages they serve. Exploring the social connectedness of midwives in their communities can reveal areas in which they need additional support, and ways they could benefit their communities beyond their clinical role.

Objective: to examine rural auxiliary midwives' social connectedness to the communities they serve.

Design: embedded, mixed methods design combining social network case studies with semi-structured interviews.

Participants and setting: midwives were recruited for semi-structured interviews during technical trainings held in Koutiala in southern Mali. Social network analyses were conducted among all adult women in two small villages purposively sampled from the Koutiala region.

Methods: 29 interviews were conducted, transcribed, and coded using NVivo (Version 9) to qualitatively assess social connectedness. In two villages, the complete social networks of women's friendships were analysed using UCINET Version 6 (n=142; 74). Rank-orders of actors according to multiple measures of their centrality within the network were constructed to assess the midwives' position among village women.

Findings: both local and guest midwives reported feeling high levels of social integration, acceptance, and appreciation from the women in their communities. Specific challenges existed for guest or younger midwives, and in midwives' negotiations with men. In the two sociometric analyses, both the local and guest midwives ranked among the most influential social actors in their respective villages.

Key conclusions and implications for practice: though they hold a unique position among other rural women, this study suggests that midwives in Koutiala are well connected socially, and may be capable of becoming effective agents of network based-behavioural health interventions. Additional support is warranted to help midwives affirm a credible professional status in a male-dominated society, especially those of local status and younger age. Programme planners and policy-makers should consider the potential of midwives in communication when designing behaviour change interventions for women in similarly underserved areas.

Keywords: Mali; Maternal health; Social networks.