Locating the Informal in the Formal?

This paper explores the influences that led to the development of the Free Health Care<br>Initiative (FHCI), which requires the provision of free health services for pregnant<br>women, lactating mothers, and children under the age of five years. The paper will<br>explore the impact of the policy on women actors as both recipients and informal<br>providers of health care in post-war Sierra Leone. Since the end of the Sierra Leone<br>civil war in 2002, there has been much focus on maternal and child health issues due<br>to the staggeringly high maternal and child mortality rates, when compared to the<br>rest of the world. Currently, international considerations exist such as the Convention<br>for the Elimination of All Forms of Discrimination Against Women (CEDAW) and the<br>Millennium Development Goals (MDGs) to ensure nations are responsive to women’s<br>health concerns. These often externally driven policies may not be based on internal<br>motivation, and may have negative local consequences.<br>Although the FHCI has improved accessibility of clinical services provided by the<br>government by eliminating user fees, a provision was made to eliminate the services of<br>traditional birth attendants (TBAs), who historically provided affordable birth services<br>for women in rural regions of Sierra Leone. The new health policy thus criminalizes<br>the actions of TBAs, stripping them of the ability to practice their craft and earn a<br>living. This paper examines the sometimes-contradictory results inherent when international<br>laws and mandates get translated into local contexts and problematizes the<br>uni-dimensional ways in which women’s empowerment is often promoted.

本研究探讨了推动免费医疗倡议（Free Health Care Initiative, FHCI）出台的各类影响因素，该政策要求为孕妇、哺乳期母亲以及5岁以下儿童提供免费医疗服务。本文将探析该政策对战后塞拉利昂女性群体的影响——这些女性既是医疗服务的接受者，亦是非正式医疗服务的供给者。自2002年塞拉利昂内战结束以来，由于孕产妇与儿童死亡率远高于全球平均水平，当地长期高度重视妇幼健康议题。当前，国际社会推出了《消除对妇女一切形式歧视公约》（Convention for the Elimination of All Forms of Discrimination Against Women, CEDAW）与千年发展目标（Millennium Development Goals, MDGs）等框架，以推动各国重视女性健康诉求。此类政策往往由外部驱动，未必契合本地内生需求，反而可能对当地产生负面影响。尽管免费医疗倡议通过取消诊疗服务费，提升了政府提供的临床服务可及性，但该政策同时纳入了取缔传统助产士（traditional birth attendants, TBAs）服务的条款——而传统助产士长期以来为塞拉利昂农村地区的女性提供了负担得起的接生服务。这项新医疗政策因此将传统助产士的执业行为定为刑事犯罪，剥夺了她们赖以谋生的执业权利。本文探讨了国际法律与指令落地本土语境时必然存在的内在矛盾，并对当前推广女性赋权时常采用的单一维度路径提出了批判性反思。