Locating the Informal in the Formal?

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