Author Siri Suh presents an interesting dynamic that healthcare providers face in her work Dying to Count. Her ethnography focuses on Senegal, a country of Islamic majority with relatively strict abortion laws. These laws coincide with cultural expectations of restraining from sexual relations until marriage and of desired pregnancies. Suh writes that, in Senegal, “the concept of an ‘unwanted’ pregnancy within marriage falls beyond the boundaries of appropriate femininity, in which motherhood is a natural, desirable, and inevitable outcome of sexuality.” (86) To uphold this culture, authorities place pressure on healthcare workers to disclose induced abortions so that legal action can be taken against the mother. However, healthcare workers in Senegal “distinguish their role in managing abortion complications from that of law enforcement officials.” (88) One midwife who Suh interviewed stated that “even if the patient had an induced abortion… it’s not my problem. The obligation of a midwife is to care for the patient.” (88)
These dual pressures put healthcare providers in a bind. On one hand, they can follow legal expectancies and tip off authorities about suspected illegal abortions which they encounter. On the other hand, they face ethical and moral obligations to provide care for the patient, whether the abortion was induced or a miscarriage. To balance these pressures, healthcare workers in Senegal tend to alert authorities only when there is concrete evidence that a patient received an induced abortion: one head gynecologist stated that he is “not obligated to send if there’s suspicion, but not evidence.” (92) In the large majority of cases without evidence, healthcare providers chart the patient as having a miscarriage so that they can provide adequate PAC. Suh demonstrates how countries like Senegal attempt to balance legal repercussions regarding abortion and the provision of best care, when the end goal is to limit maternal mortality.