Configurations familiales et accès des enfants aux soins à Nouakchott (Mauritanie)

Research Framework: Despite the wide array of medical facilities in Nouakchott, access to healthcare for children constitutes a major public health issue and a financial burden for parents with limited resources. Objectives: The objective of this article is to analyze how children depend on their family to access healthcare, and how their therapeutic journey is impacted by the roles of the child’s entourage. Methodology: The foundation of this contribution lies within the anthropology of childhood, solidarity and family links. It is based on research carried out between 2013 and 2015. It integrates observations on pediatric wards with roughly fifty interviews conducted with children and their relatives. Results: The family’s response to disease depends upon socially constructed relationships, as well as on individual initiatives and the situational context. Parents are at the center of health-related decisions; mothers are usually held accountable for the health of the child, whereas fathers provide the financial means to access care. Although the extended family provides support, parents generally find themselves alone in dealing with catastrophic healthcare costs. The status of the children in their family and the variations of the family configurations determine their access to healthcare. The status accorded to the child and its variations in changing family configurations modifies their access to care. Conclusions: While parents describe their strategies for accessing care, children highlight the inertia of their entourage in the face of their pains. They describe how their parents' efforts alternate with times of waiting, during which they have to bear their pain. Contribution: Family solidarity tends to be idealized, but it appears to have little effect on access to health care, leaving some children isolated medically. Investments in understanding family configurations would benefit the development of public policies and international aid programs for children's health