Childbirth in Tunisia : Implications of a decision-making model

The use of a decision-making model for the collection and analysis of health related data provides insights into the factors influencing community definitions of health service utilization. The significance of such a model is demonstrated in this paper through an examination of women's decisions concerning the use of perinatal services in the Tunisian town of Ksar-Hellal. The study of health care decisions has implications both for the development of medical anthropology theory and for the development of social policy. Faced with a situation of medical pluralism, women in Ksar-Hellal choose between three alternative systems of childbirth: in the home with a lay midwife (qabla), in the home with a medically trained midwife (sage femme) and in the hospital with medically trained personnel and medical obstetric techniques. Through an examination of sociocultural and economic factors affecting these choices, a set of rules is formulated which predict the conditions under which a woman will choose one alternative rather than another. The conditions affecting the childbirth decision-making process in Ksar-Hellal include a number of interactional factors labeled 'Emotional Support/Humiliation-Anxiety Avoidance", as well as factors related to cost, the degree of seriousness of the woman's physiological condition, and evaluation of the effectiveness of medical treatment. By presenting an analysis of the processes underlying individual health care choices, a predictive model of health care decision-making contributes to the understanding of health service utilization. Such a model presents significant insights for policy planning, as suggested by the case of childbirth decision-making in Ksar-Hellal.