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Self-medication versus consultation : individual autonomy and dependence in health decisions
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Individuals address health problems in one of two ways: in their home or social environment, or by calling upon specialists, for both of which medications play an important role, from pharmaceuticals to herbal treatments. This chapter examines how social determinants, conceptions of autonomy, and popular knowledge shape behaviors around medication use. The situations we studied in Benin and Ghana, in contexts where health expenditures are only infrequently covered by an insurance system, underline trade-offs between different forms of self-medication and specialist consultation. Mobilizing extensive experiential knowledge, self-medication reflects a form of positive autonomy, regardless of socioeconomic status or living situation. However, when people do not feel able to manage their health problems on their own, this autonomy is largely constrained. Socioeconomic inequalities are clearly expressed in the contexts we studied. So as for territorial inequalities: the inhabitants of the capital cities and the semirural and rural areas do not have the same options for health care. Socioeconomic inequalities do not act in rural context, as available services are largely the same regardless of socioeconomic status. This chapter ends wondering whether the extensive and omnipresent pharmaceutical distribution in the Global South is a factor in devaluing the status of biomedical expertise.
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