The implications of role expectations for birth assistance among Bariba women

Throughout the Third World, a notable trend has been the proliferation of parallel health care systems in which cosmopolitan medical services co-exist with a variety of indigenous health care services, and client populations must make decisions regarding the preferred choice among the existing alternatives. Correspondingly, Bariba women in People's Republic of Benin, West Africa, who seek obstetrical care have an increasing number of available options from which to select, including government hospitals, maternity clinics, private clinics, and a variety of indigenous practitioners. An examination of the factors influencing choices of birth assistance among Bariba women suggests that attributes of indigenous midwives such as status characteristics and type of training serve as significant considerations for clientele selecting obstetrical care. Characteristics discussed as salient features of the midwife include religion, age, marital status, education, apprenticeship, and certain personal qualities such as courage and lack of modesty. In addition, features of the midwifery role are delineated; for instance, the role of indigenous midwife involves a great deal of variability in contrast to that of the government nurse-midwife, which appears as a more narrow specialization. In order to fulfill role expectations, the indigenous midwife must demonstrate attributes which fall within an acceptable range to the client population, thus rendering her reasonably homophilous. Homophily is defined as 'the degree to which pairs of individuals who interact are similar in certain attributes such as beliefs, values, education, social status'. The data suggest that a healer, in this instance an indigenous midwife, is selected in order to accomplish a particular task. A client assumes certain characteristics of the role occupant are requisite for the healer to be effective and competent. Clients and midwives are found to be homophilous in that they share concepts of causation, beliefs, values and role expectations. Where the healer is not homophilous with the client, the absence of homophily operates to deter prospective clients from utilizing obstetrical services. Thus in the case of the rural client/government midwife relationship, the respective role occupants are shown not to be homophilous. In contrast to the indigenous midwife, the government midwife does not share significant attributes, values and expectations with her client and this lack of homophily deters prospective clients from selecting the government midwife as an option for birth assistance.