Navigating health system constraints and risks for childbirth care in rural Guinea: the role of women's agency

Women with reproductive desires and needs face various health system constraints in the Global South. Certain biomedical practices, such as C-section, are also perceived by women as risky. In this paper, we explore how women in one of the Susu villages in western Guinea use their agency to navigate health system-related constraints and risks. This was a twelve-month ethnography using focus group discussions, individual in-depth interviews, informal conversations, direct observations, carried out between April 2020 and August 2022 in the Maferinyah village of Guinea. Using the concepts of reproductive navigation, collective agency, street-level bureaucracy, and trust, we showed that women in labor creatively navigate these constraints and risks, relying in different ways and degrees on their social networks, including midwives. Woman’s social relationships are an important part of a collective agency to navigate her reproductive trajectory. We also found that reproductive navigation is structured by women’s relationships with individual care providers, their ability to mobilize social resources, their perception of risks associated with medical practices, and the health system constraints they face. This calls for political actors and healthcare providers to prioritize actions to mitigate health system constraints and build trust in that system.