Childbirth practices in Benin are strongly influenced by the sociopolitical structure of the West African country.
Background Social structure and organization
About 50 cultural groups are represented in Benin, with the most numerous being the Fon (39.2%), Adja (15.2%), Yoruba (12.3%), and Batombu/Bariba (9.2%). The population of Benin was estimated in 2022 to be around 13,750,000, with 50% of the population living in urban environments and a 4% rate of urbanization. Benin ranks 163rd out of 177 in the United Nations Human Development Index. Forty-four percent of the population is under age 15, and 42% are literate.
The practice of polygamy persists, though it has seen a significant decrease in recent time. Between 1996 and 2006, the percentage of men in polygamous marriages went from 33% to 26%, and in women it went from 50% to 42%. On average, women marry by ages 18–19, and men typically marry by age 25.
Many languages are spoken in Benin though the official language of the country is French. Fon and Yoruba are most prevalent in the south, while the north has about 6 main indigenous languages.
Political and economic system
Since independence on August 1, 1960, Benin has provided a model of democracy in West Africa. In December 1990, the constitution that determines the current electoral regime was established. The constitution ensures the human rights of the population of Benin and ensures universal suffrage. Fifteen departments were recognized in 1999 in an effort to decentralize governing bodies.
Agriculture continues to be the primary economic activity in Benin. The country exports cotton, peanuts, and palm products and focuses domestically on corn, yam, manioc, beans, millet, and sorghum. Industries such as textiles, food processing, construction materials, and cement constitute the greatest portion of the industrial sector.
Religion
Religions practiced in Benin include the following: Christian (42.8%), Muslim (24.4%), Vodoun (17.3%), and "other" (15.5%). Of the percentage that identify as Christian, 27.1% are Catholic, 5% are Celestial, 3.2% are Methodist, and 2.2% are other Protestant. In Benin, people who practice on religion such as Christianity or Islam may also have had significant influence from traditional religious beliefs, such as vodoun, and practice aspects of vodoun along with Christianity or Islam.
Physical environment
Benin is bound by the Atlantic Ocean to the south, Togo to the west, Burkina Faso and Niger to the north, and Nigeria to the east. The climate is tropical: heat and humidity persist for most of the year. The average temperature is , with temperatures peaking in March and dipping in August. July to October marks the rainy season.
Health and illness theories
Health and illness are often closely related to spiritual beliefs and practices in Benin. The practices of vodoun and traditional medicine reflect spirituality in illnesses as well as in cures. Among the Bariba in the north of Benin, folk illnesses are identified as those groups of symptoms for which science-based medicine provides neither an etiology nor a cure. Explanations of such illnesses are often spiritual in nature, deriving from the ill will of another person or an interaction with certain elements of nature. With colonialism came the advent of hospitals to treat illnesses and in which women would even give birth. Consumers of traditional medicine have expressed skepticism of hospitals because local healers are known to keep secrets well, while providers in hospital settings developed a reputation of non-adherence to patient confidentiality.
Traditionally, healers in northern Benin would not ask for money for services, but rather patrons would offer them gifts when treatments were administered. The advent of hospitals and their associated fees presented a model of health care that was previously counter-intuitive to the Bariba people.
Women's Health Statistics The maternal mortality ratio in Benin has been estimated between 473 and 990 deaths per 100,000 live births. The most recent Demographic and Health Surveys maternal mortality estimate for Benin is 498 deaths per 100,000 live births. Infant mortality is estimated at 61.56 deaths per 1,000 live births. Life expectancy at birth is 59.84 years; for women it is estimated at 61.14 years. The fertility rate in Benin is 5.31 children per woman. HIV/AIDS incidence is 1.2%, which means about 60,000 people Benin are living with HIV/AIDS. The under-5 mortality rate decreased from 160 deaths per 1,000 in 2001 to 125 deaths per 1,000 in 2006.
Between 1982 and 1996, fertility declined only modestly and concentrated in younger women, from 6.4 to 5.2 children per woman in cities and from 7.4 to 7 children per woman in rural areas. The mean ideal family size in 1982 was 7.4 children and in 1996 dropped to 5.8 children. Overall contraceptive use in Benin is estimated at 16%, and most of this percentage is due to periodic abstinence (7%) and withdrawal (5%). In 2006 it was estimated that 6% of married women use a modern method of contraception, and 30% of married women desire to limit and/or space their pregnancies but do not use a modern contraceptive.
Since 2003, female genital mutilation in any form was deemed illegal in Benin. Some forms of female genital mutilation continue to be practiced in the north of the country, and 13% of women reported in 2006 that they had undergone some form of genital mutilation. Bariba women have the highest percentage of female circumcision, 74%. Other groups in the north still practice forms of genital mutilation, including the FulasIn or Peulhs; in . (72%) and Yoa/Lokpa (53%). Female circumcision was not reported among the Fon or Adja. Of the women who reported having undergone a form of female circumcision, 49% had the procedure done before age 5.
Though 76% of people in Benin live within 5 km of the nearest health facility, only 44% of this population use their services. Among the top reasons for visits to the health center are malaria, acute respiratory infections, and diarrhea. These three illnesses are responsible for 70% of visits to health centers and 65% of deaths under age 5.
Pregnancy behaviors and beliefs Prenatal care and pregnancy attitudes A strong percentage of women in Benin receive prenatal care at some time during their pregnancy. Estimates have indicated that 97% of women received prenatal care in 1996 and 88% in 2006. In 2006, it is estimated that 93% of women in urban areas and approximately 85% of women in rural areas receive prenatal care, though rural estimates vary by department. About 61% receive the four prenatal visits recommended by the World Health Organization. Of those women who have prenatal consultations, 86% took iron supplements, and about 45% had any kind of nutritional counseling. The use of technology in prenatal consultations has increased; in 2001, about 8% of women had an ultrasound, while in 2006, 21% had an ultrasound. The recommended two doses of tetanus toxoid vaccine were received by 56% of women in 2006. It is most likely that a woman seeking prenatal care will use the services of a midwife for consultations; about 80% of women see a midwife or nurse prenatally.
Motivations to seek out prenatal care include symptoms that prevent the completion of daily tasks, indications of abnormality such as bleeding, pain, or fever, fears of miscarriage, and fears of repeated complications seen in prior pregnancies. If a woman does not notice any indications of complications during early pregnancy, she may opt to wait until late into the second trimester or third trimester to seek out prenatal care. Barriers to accessing prenatal care include cost and transportation. Women in Benin report that negotiating funds from husbands for prenatal care or associated prescriptions can lead to arguments between spouses as well as frustrations between patient and provider.
In Benin, pregnancy is often a way to gain status and respect in one's community. Getting pregnant can therefore become more a pressure from society than an individual's choice in many cases. Some women in Benin report that pregnancy indicates good fortune, but others cannot help but express concern about the extra costs another child will bring. Beninese women also describe pregnancy and birth as a time of great vulnerability, and more specifically, as a time 'where life and death converge'.
Contraception Family planning has changed drastically in Benin since a 1920 law that forbade any contraception propaganda. Since 1971, the Benin Family Promotion Association, a nongovernmental organization, has supported contraceptive use in select cities and constitutes the first formal family planning initiative in Benin. In 1982, the government began a family welfare project with the aim to include family planning in maternal and child health initiatives. In 1996, about 80% of women knew of modern contraception, but many say that unless they had already reached their desired number of children, they would not use it due to rumors about the dangers of potential result in sterilization. In 2003, a law was established that states that everyone has a right to be informed and use the legal family planning method of their choice.
Contraceptive use in Benin may include traditional and modern methods, and many cultures in Benin value natural child spacing. Primary methods of birth control are abstinence from sex and lactation after the birth of a child. In the region of West Africa, use of modern contraceptives among married women is about 10%, and the desired number of children continues to be high. Modern contraceptive use in Benin is estimated at 3.5%. Younger women tend to use contraceptives more than older cohorts (18% use for ages 20–24). About 11% of women under age 20 in Benin use some type of family planning, whether traditional or modern methods. Sexually active unmarried women have a higher contraceptive use around 50%, 14% of which is modern contraception.
The average interval between births is 34 months. A woman who gives birth too soon after the previous child may lose the respect of her community. The Fon word kpedovi refers to the older of a pair of children born too close together. Kpedovi gained the reputation of being under-nurtured because their mothers weaned them earlier and focused more attention on the younger child. Women in Benin state reasons for adequate child spacing as concern for the health and well-being of both children nutritionally and psychologically. They state that having children too soon after each other is also potentially detrimental to the mother's health.
Therapeutic abortion is illegal in Benin, so incidence is difficult to measure. It is used for the purpose of child spacing and limiting number of births across all ages and social classes.
Labor Place The place of labor and birth differs from north to south. In the north, Bariba women have traditionally idealized labor and birth to occur alone and in the home with no attendants. Bariba women will labor with the intention of letting no one know that labor has begun; they will go about their daily tasks as normal. In the south, where it is more common to deliver in a health facility, labor may occur at home for a portion of the time then continue at the facility.
Pain The perception of and reaction to pain also differ greatly from north to south. Among the Bariba in the north, it is socially expected that one respond to pain with stoicism, indicating the level of courage that is inextricably associated with the Bariba people. For women, labor and childbirth is the time at which one can show her greatest virtue; to respond verbally or physically to pain would be to shame oneself and her family. As a Bariba proverb states, 'Between death and shame, death has the greater beauty'.