In any society in the world, where unfairness and injustice arise, they can be seen as the product not only of local-level phenomena but also as originating in the broader social schema that perpetuates inequity. Though such troubles seem capable of coming into being in any country in the world, nowhere are these difficulties more evident than on the continent of Africa. The country of Mali, in particular, sits in a precarious position, bordered by the harsh and, with the onslaught of global warming, ever-expanding and increasingly inhospitable Saharan desert on one side, and with political pressures making themselves known from many directions. However, to approach the study of the country’s ailments as a whole in a short discussion would be folly; rather, it is best to find an appropriate narrative of what is essentially a case study, and in this case, such a work is found in Monique and the Mango Rains, by Kris Holloway and John Bidwell. In this thorough examination of Mali’s health care system as seen through the eyes of one woman, embedded in a quite moving tale, it becomes obvious on a syndemic level that the social arrangements of living in Mali are at least partially responsible for much of the social suffering seen there in the form of women having inadequate access to proper healthcare as well as experiencing a truncation of their rights as human beings.
To begin an exploration of the topic of women in Mali and their access to healthcare, it is first necessary to examine the role that the economy and the political unrest prevalent in Mali take in influencing the circumstances behind the issues. The economy in Mali is such that many rural peoples rely almost exclusively on what subsistence agriculture they can eke out of the harsh landscape, perhaps having a little extra to barter or sell at market, but generally only scraping by. This is what leads to the shocking practice that Holloway and Bidwell describe of women who have just given birth being forced by social pressures to go right back into the fields and start working again after mere hours have passed, aching and with the burden of their newborn babies weighing them down. However, the perhaps legitimate cultural perception in the town of Nampossela is that a woman simply cannot spare the time away from the fields, lest her family starve as a result. Ironically, it is this very attitude that gives rise to the fact that “a Malian woman’s lifetime risk of dying in pregnancy and childbirth [is] one in twelve, compared to a U.S woman’s risk of over one in three thousand” (Holloway and Bidwell 8). Truly, a one-in-twelve risk of dying from something that is a normal part of the lives of most women in Mali is excessive. Inequity arises here is the fact that men, of course, do not undergo pregnancy and childbirth, and thus do not face the same risk of mortality. Obviously, greater healthcare could help reduce the risk for women, but the unavailability of such care is due not only to poverty, but also another factor contributing to the syndemics of the situation, which is the political unrest present in the country. This unrest, which sometimes comes close to being outright war, makes it more difficult for what funds are present to reach the people whose health they are intended. In addition, travel becomes perilous when the country is in a state of unrest, making it more difficult, for example, for women to reach Monique, the midwife and often hero of Monique and the Mango Rains. Though Monique had relatively little training compared to an obstetrician in a developed country, nevertheless her expertise, employed at the old birthing clinic or at the new one Kris Holloway helped get built, provided for better outcomes for the women who came to see her—if they could only safely reach her from outlying villages. Thus, it is clear that the combined forces of the economy and the state of political unrest in Mali contributed to often dire straits for women there.
The role of gender in social inequity in Mali cannot be underestimated. In this patriarchal society, even Monique, an unquestionably strong-minded woman, came to be betrothed to a stranger at the age of five, leading to a troubled and abusive arranged marriage. As woman in Mali do not even have the social power to make decisions about what happens to their own bodies, when Monique rightly observed that too many pregnancies too close together caused poorer outcomes for both mother and child and decided to start taking birth control pills, she had to do so in secret for fear of her husband finding out (Holloway and Bidwell 102). This demonstrates the ways in which women in Mali were and sometimes still are treated as wards of their husbands, incompetent children who cannot even make decisions about their own health care. Though of course caution must be used in examining another culture from an outsider’s perspective, where health is concerned, as in this case, sometimes it can be appropriate to make judgments such as that deeply ingrained sexism in the culture of Mali, combined with the country’s status as a developing nation, directly causes women to suffer from preventable illnesses.
Overall, women in Mali often have little power over becoming victims of the systemic troubles of the country, from the impoverished economy and constant state of political unrest to the differences in how women and men are treated in local cultures. In order to remedy some of these ills, however, it is necessary to look beyond Mali and even beyond Africa; one must instead examine the role the whole world plays in perpetuating such situations. Ultimately, healthcare in Mali is not an issue for Mali alone. These problems are the problems of a global society still struggling to create equity.
In order to create greater equity around the issue of global health, it can be a valuable thought experiment to imagine oneself in the powerful fictional position of the monarch of the globe. Once in this position, it immediately becomes obvious that it is the unequal distribution of resources around the world that in part creates difficulties for developing nations and for poor people and disadvantaged minorities even in developed nations. To see what a society would look like if resources were distributed more evenly amongst its members, one need only look to Sweden, a socialized country well known for its high rates of happiness and health thanks in large part to its multiple social safety nets, both economic and health-oriented. However, humans no longer live in a nationalistic society where outcomes only matter for one’s own nation; now, a type of global society has arisen, and thus, it would behoove the world to be more like Sweden. Yet simultaneously, it is also true that globalization itself has played a role in the issues with which developing nations find themselves faced.
Globalization, combined with rampant and unrestrained capitalism, has driven developing countries further and further into poverty that is vastly disparate from the indulgent and luxurious opportunities given citizens of more developed nations. The very climate change caused in large part by developed nations has led to the erosion of traditional systems of agriculture in countries like Mali. In order to stem the encroaching tide of inhospitable climes over the land, it is necessary to create and enforce strict policies regarding the use and consumption of fossil fuels. In addition, better economic equality would be achieved if the citizens of wealthier nations were required, perhaps by means of some sort of global tax system, to give a portion of their wealth to those less fortunate. By undertaking all these actions, the hypothetical monarch of the world could create good outcomes indeed.
Holloway, Kris, and John Bidwell. Monique and the Mango Rains: Two Years with a Midwife in Mali. Long Grove, Ill: Waveland Press, 2007. Print.