Keeping Children Healthy: The Challenge of Preventive Care among Women in Southwestern Nigeria

INTRODUCTION This study focuses on preventive health care. In Third World countries such as Nigeria greater attention is given to curative care and the examination of preventive behavior tends to be neglected. Furthermore, studies of prevention are more likely to focus on the formal health care system. Lay preventive practice draws less attention, even though the informal or lay health care system is responsible for most of the care given in any community (Illich, 1975; Dean, 1986). Within households and communities people do things on a daily basis to safeguard their health and that of their dependents. Wilson has argued that "Doctors are authoritative on the subject of illness, but in matters ofhealth carry the same authority as, for example teachers, mothers, environmentalists..." (Wilson, 1975:115 emphasis added). He believes that in communities there are many "key people" (Wilson, 1976:116) who help to promote health. This study examines the activities of one group of key persons - mothers, who, as a result of gender roles bear a heavy responsibility for the health care of families. The study explores the preventive activities of low income women (food traders and market women) in Ile-Ife, a Yoruba town in Southwestern Nigeria. The focus is on the health care of children, the concerns mothers have over children's health, and the problems women face in trying to keep children healthy. The interest here is primarily prevention (i.e., what is done so that children do not become ill), which includes preventive medication (e.g., ointments, food, etc.), preventive treatment (no medication, but involves lay prescribed activities such as exercise, rest, bathing, massage, etc.) and preventive care (no medication, but involves other activities such as prayer, sacrifices, etc.). Historically, there has been a lot of debate as to whether or not Africans had a concept of prevention prior to Western contact (Jansen 1973). African healing systems are based on very different principles from Western systems, and beliefs and practices about prevention evolve from a people's conceptualization of disease causation. Therefore all cultures, including indigenous African cultures, develop preventive measures to protect individuals, households and communities from harm/disease. What appeared as nonexistent to colonial physicians, travelers and scholars was in fact embedded in local belief systems. African encounter with European medicine (biomedicine)' opened up new possibilities and this study examines how women use local as well as Westernstyle preventive care in caring for young children. To understand patterns of health behavior in Nigeria, I have found the modes of production perspective useful (Pearce, 1986; Pearce, 1989; Pearce, 1994). This approach to social change assumes that nonWestern people blend together aspects of their own culture and the incoming Western culture. In the health sector, for instance, individuals combine Western and local healing beliefs and practices to serve their immediate needs. This perspective was originally developed as a critique of both modernization and underdevelopment theories (Taylor, 1979). The former argues that nonWestern societies were basically static and traditional.' They would evolve into 'modern'societies as people began to reject their indigenous way of life in favor of Western culture (Parsons, 1971; Eisenstadt, 1966). Underdevelopment theorists, on the other hand, believe that contact with the West has been very problematic. Colonialism and the attendant exploitative practices resulted in cultural dependency, economic depression and social chaos in Third World nations (Amin, 1976; Gunder Frank, 1975). Distinct from these two approaches, the modes of production perspective attempts to unravel the ways in which people blend different traditions, For instance, wedding ceremonies now weave together local and Western practices. Among the Yoruba in Southwestern Nigeria, weddings last two (sometimes three) days. …