In pursuit of the demographic dividend: the return of economic justifications for family planning in Africa.

This article examines the resurgence of economic justifications for investment in family planning in Africa. In the Cold War period, population control programmes were at the forefront of the Northern development agenda for the Global South; rapid population growth was cast as the enemy of national economic advancement and modernisation. At the United Nations Conference on Population and Development in 1994, global leaders signed on to a Platform of Action that sidelined economic and environmental concerns with population growth in favour of a human rights approach to family planning. Over the past decade, key sectors of the development community have regained their enthusiasm about the economic and social benefits of reducing fertility in sub-Saharan Africa. A wide variety of multilateral organisations have joined forces with African governments in a common pursuit: lower fertility to achieve demographic transition and harness the demographic dividend. The article contends that efforts to catalyse the demographic dividend are problematic because pursuing dramatic reductions in fertility (rather than reproductive and contraceptive autonomy) violates human rights approaches to sexual and reproductive health.

Correction: Vialard, L., et al. Toward a Socio-Territorial Approach to Health: Health Equity in West Africa. Int. J. Environ. Res. Public Health 2017, 14, 106.

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Toward a Socio-Territorial Approach to Health: Health Equity in West Africa.

This study contributes to the literature about the effects of space and place on health by introducing a socio-territorial approach to urban health disparities in West Africa. It explores how urban spaces, specifically neighbourhoods, are shaped by social and economic relations and strategies of territorial control. We examine the potential influence of socio-territorial processes on vulnerability to disease, access to medical care, healthscapes, and illness experiences. Our research was conducted in Senegal and relied on a mixed methods design. We identified four neighbourhoods that represent the socio-spatial heterogeneity of the city of Saint-Louis and utilized the following methods: geographic and anthropological field research, household surveys, health knowledge and behaviour surveys, clinical exams, and illness interviews. Our results highlight the socio-territorial processes at work in each neighbourhood, clinical findings on three health measures (overweight, high blood pressure, and hyperglycaemia) and health experiences of individuals with hypertension or type II diabetes. We found significant differences in the prevalence of the three health measures in the study sites, while experiences managing hypertension and diabetes were similar. We conclude that a socio-territorial approach offers insight into the complex constellation of forces that produce health disparities in urban settings.

Regulating sex work: subjectivity and stigma in Senegal.

Senegal provides a unique example of a sub-Saharan African country with a legal framework for the regulation of commercial sex work. While registering as a legal sex worker affords women access to valuable social and medical resources, sex work is condemned by Senegalese society. Women who engage in sex work occupy a socially marginal status and confront a variety of stigmatising discourses and practices that legitimate their marginality. This paper examines two institutions that provide social and medical services to registered sex workers in Dakar: a medical clinic and a non-governmental organisation. It highlights the discourses about sex work that women encounter within these institutions and in their everyday lives. Women's accounts reveal a variety of strategies for managing stigma, from discretion and deception to asserting self-worth. As registered sex workers negotiate their precarious social position, their strategies both reproduce and challenge stigmatising representations of sex work. Their experiences demonstrate the contradictory outcomes of the Senegalese approach to regulating sex work.

HIV/AIDS in mid-sized cities in Senegal: From individual to place-based vulnerability.

In Senegal, recent data indicates that the HIV epidemic is increasingly driven by concurrent sexual partners among men and women in stable relationships. In order to respond to this changing epidemiological profile in Senegal, multi-lateral and national AIDS actors require information about these emerging trends in unstudied populations. To that end, this study has several objectives, first, to assess local dynamics of sexual behaviors among individuals at popular socializing venues in areas at increased risk of HIV transmission; and then to examine how particular venues may influence risks of HIV transmission. In 2013 we collected data at 314 venues in 10 cities in Senegal using PLACE methodology. These venues were listed with collaboration of 374 community informants. They are places where commercial sex workers, MSM, and individuals who are not part of any identified risk group socialize and meet new sexual partners. We conducted 2600 interviews at the 96 most popular venues. A significant portion of the sample reports buying or selling sex and the majority engaged in behavior considered high-risk for transmitting sexual infections. Almost a quarter of patrons interviewed in venues were young people aged 15-24 years. Types of venues described were very diverse. Half of them were venues (n = 156) where sex workers could be solicited and almost a third were venues where MSM could meet male partners (n = 90). The study showed existing pockets of vulnerability to HIV in Thies, Bignona or Saly that are not evident from aggregate HIV data. These early findings suggest links between risky behaviors and type of venue on the one hand and type of city on the other hand. Finally, these findings offer complementary insight to existing studies of HIV vulnerability in Senegal and support a case for venue-based interventions.

Mbaraan and the shifting political economy of sex in urban Senegal.

This paper examines transactional sex in Dakar as a window into broader processes of social and economic change in urban Senegal. Patterns of heterosexual behaviour in Senegal's capital (late and increasing age at first marriage for women, a relatively high divorce rate and a rise in transactional sex) reflect a confluence of socioeconomic forces that curtail some forms of heterosexual union and facilitate others. Our analysis focuses on the rise of mbaraan, a practice in which single, married and divorced women have multiple male partners. We argue that while mbaraan is in part an expression of women's agency and a transgression of dominant gender norms, it also reflects women's social and economic subordination and their inability to achieve self-sufficiency independent of men's financial support. We suggest that this urban phenomenon is the outcome of contradictory opportunities and constraints that women face as they grapple with material insecurity and marital disappointments.

From population control to AIDS: conceptualising and critiquing the global crisis model.

This essay takes as its point of departure comparative analyses of the population control movement and the global AIDS response. We argue that the responses to both rapid population growth and AIDS reflect a particular model for approaching development issues: the global crisis model. This model provides a framework in which development issues become classified as (1) global in scope, (2) highly urgent and unique, (3) a threat to international stability and (4) addressable through a concerted global response. By reviewing the population control movement and the past, present and possible future of the AIDS response, we examine the evolution of the global crisis model and its consequences in shaping development priorities, problems and solutions. We argue that the model mobilises significant financial resources, but it skews the allocation of development assistance, creates narrow, technical interventions, and fails to examine or remedy the social inequalities that produce health and development disparities.

Diaspora, faith, and science: building a Mouride hospital in Senegal.

This article examines a development initiative spearheaded by the members of a transnational diaspora ­ the creation of a medical hospital in the holy city of Touba in central Senegal. Although the construction of the hospital is decidedly a philanthropic project, Hôpital Matlaboul Fawzaini is better understood as part of the larger place-making project of the Muridiyya and the pursuit of symbolic capital by a particular Mouride "dahira". The "dahira's" project illuminates important processes of forging global connections and transnational localities, and underscores the importance of understanding the complex motivations behind diaspora development. The hospital's history reveals the delicate negotiations between state actors and diaspora organizations, and the complexities of public­private partnerships for development. In a reversal of state withdrawal in the neo-liberal era, a diaspora association was able to wrest new financial commitments from the state by completing a large infrastructure project. Despite this success, we argue that these kinds of projects, which are by nature uneven and sporadic, reflect particular historical conjunctures and do not offer a panacea for the failure of state-led development.

Courting success in HIV/AIDS prevention: the challenges of addressing aconcentrated epidemic in Senegal.

This article presents findings from a study of HIV/AIDS programmes for urban sex workers in Dakar, Senegal. The objective of the research was to assess HIV prevention and treatment efforts to date, and to identify challenges that must be overcome in the long term to reduce the spread of HIV in Senegal. The research team organised four day-long community dialogues, in June 2008, with registered and unregistered sex workers in the Senegalese capital. In addition to these sessions, we conducted interviews with physicians employed by the Senegalese Ministry of Health, leaders of sex-worker organisations, and directors and staff at non-governmental organisations whose programmes target sex workers and other vulnerable groups. Our findings indicate that Senegal's public health strategies have been largely effective at containing the country's HIV epidemic, but not at addressing the social drivers of HIV transmission or protecting the rights of sexual minorities, such as sex workers and men who have sex with men. For Senegal's HIV/AIDS response to continue on a successful path, it must expand to include structural interventions and incorporate a human-rights approach.

The anti-politics of health reform: household power relations and child health in rural Senegal.

This article employs ethnographic evidence from rural Senegal to explore two dimensions of health sector reform. First, it makes the case that health reforms intersect with and exacerbate existing social, political, and economic inequalities. Current equity analysis draws attention to the ways that liberal and utilitarian frameworks for health reform fail to achieve distributive justice. The author's data suggest that horizontal power relations within households and small communities are equally important for understanding health disparities and the effects of health reform. Second, the article explores how liberal discourses of health reform, particularly calls for 'state-citizen partnerships' and 'responsiblization', promote depoliticised understandings of health. Discourses associated with health reform paradoxically highlight individual responsibility for health while masking the ways that individual health practice is constrained by structural inequalities.

Neoliberal reform and health dilemmas: social hierarchy and therapeutic decision making in Senegal.

In this article, I trace the links among neoliberalism, regional ecological decline, and the dynamics of therapeutic processes in rural Senegal. By focusing on illness management in a small rural community, the article explores how economic reform is mediated by existing social structures, and how household social organization in turn influences therapeutic decision making. The illness episodes relayed here demonstrate how the acute economic and social crisis facing the Ganjool region becomes written on the bodies of young men, and how the fault lines of gender and generation shape illness experiences. These narratives also illuminate the tremendous discrepancy between the lived realities of sickness and death, and the idealized models of health participation and empowerment envisioned by the state. Rather than "neoliberal subjects" who behave as rational economic actors, men and women coping with illness are social beings embedded in fields of power characterized by highly stratified household social relations.

Overlaps and disconnects in reproductive health care: global policies, national programs, and the micropolitics of reproduction in northern Senegal.

The International Conference on Population and Development (ICPD) held in Cairo in 1994 called for a global commitment to increasing women's agency and reproductive options by promoting a reproductive health agenda. Voluntary contraceptive use and the quality of reproductive health care have become the predominant emphases in family planning initiatives. Yet, many programs worldwide demonstrate a continued commitment to fertility reduction and slowing population growth. This article explores three arenas of contemporary discourse about reproductive health and family planning. Using Senegal as a case study, it highlights the significant overlaps and disconnects among global reproductive health policy, national priorities and programs, and the biopolitics of gender, marriage, and fertility that shape Senegalese women's reproductive behavior. The article points to the slow decline in national fertility rates to explore how family planning initiatives fail to address reproduction in the context of women's socio-economic challenges and cultural and religious fertility ideals.