Women's personal networks and recourse to prenatal care in Bamako

s1.IntroductionsMaternal mortality in Mali was estimated at 373 deaths per 100,000 births in 2018 [INSTAT (2019)]. While urban rates are about half those observed at the national level, they remain extremely high [Cissé and Sall (2012, p. 37)]. Most direct causes of maternal death can now be avoided, partly through prenatal follow-up, but maternal healthcare take-up remains low. In 2018, less than half (43%) of pregnant women in Mali had the four recommended prenatal visits, and in urban areas the proportion was still only two-thirds (67%). Moreover, in only a third of cases (36%) at the national level, and half of cases (54%) in urban areas, did the first prenatal visit take place during the first trimester of pregnancy, as recommended [INSTAT (2019)].sHousehold poverty is one of the main obstacles to maternal health care in low-income settings today [Ahmed et al. (2010)].1 Studies in sub-Saharan Africa—as elsewhere in poor countries—have repeatedly shown that belonging to a disadvantaged social group [Van Eijk et al. (2006)], being in a poor household [Gabrysch et al. (2011)], or having a husband or partner who cannot afford to pay for healthcare during pregnancy [Gross et al. (2012)] are key factors preventing women from attending a health center for prenatal care or giving birth there with the help of skilled personnel. In Mali, for example, only 69% of women in the poorest quintile access to (some) prenatal care, versus 97% in the richest quintile (DHS, 2018). For lack of other options, the poorest Malian women resort to traditional medicines and self-medication [Diakité et al. (1993); Diarra (1993); Berthe et al. (2009)].sIn Bamako, average daily expenditure is still only US$2.80, of which 42% is spent on food [INSTAT (2019)], leaving little for other needs such as healthcare; health insurance and social security schemes are almost entirely non-existent. To combat economic barriers to maternal health care, the Malian government has...