A maternity clinic in Mali: bioethics and moral experiences in a zone of awkward engagement

The article explores how claims about the universal applicability of biomedicine work out in the particular context of a private health care project in a non-western setting. The empirical data are derived from an ethnographic study in and around a maternity clinic that was set up on request of a village population in southwest Mali. From a Dutch mid- wifery perspective this clinic can be perceived as a zone of awkward engagement for the imagined universality of biomedicine within the local health and gender arena. Biomedi- cally trained midwives working in the clinic perceived the dissemination of information on pregnancy and birth as potentially dangerous and equated ‘modern’ healthcare with dis- pensing drugs. The midwives were not autonomous and experienced logistic and existential challenges when referring patients with obstetric complications to a higher echelon of care. Gender relations and a moral discourse of shame inhibited pregnant women’s access to healthcare facilities; local perceptions of the power of words impacted the quality of care. Biomedicine was made to fit the local context with its specific moralities. However, the new practice raises the question whether it is ethically justified. Small-scale private health- care initiatives may do more harm than good in circumstances of extreme poverty, gender inequality and poor infrastructure, and should therefore be implemented with caution.