Table 3 Illustrative quotes from research in Benin

Description and progression of the rumours

She has heard people say that as soon as you go to a health centre for care, there are some people who will receive you. They will take your name and will make you sign a paper. After that they will take some of your blood. And as soon as you give birth, they will cut the placenta of your child and analyse it. They will wait until the child is five years old. After these five years, the child will die. (…) We refused that. (Community member, woman, interview)

They have formed an association. In this association, if a woman agrees, after childbirth, a bit of the child’s placenta will be cut off and analysed. (…) Our parents have never done these kinds of analyses to us. Our parents never did that! That’s why, when they came here, we said we will kill them and sent them all away. (Community member, woman, group discussion)

Placenta beliefs and rituals

The placenta means the rope through which the child comes into the world. Each ‘koukin’ has its ritual according to the day the child was born on and these are things that must be respected. Otherwise it affects the child. (Traditional chief, man, interview)

After childbirth, so that the child is well loved by his family’s members, one does not immediately bury his placenta. It is hung somewhere in the house and its smell evaporates throughout the household. There, the child is loved by all the members of his family. Wherever he goes in this family he will be loved by everyone and we will know that he is really born from this family. (Community member, man, group discussion)

Implementation of informed consent procedures

…This is related to life and death. The placenta is the part of death. If we do not give the part of death now, immediately death will hit the child and therefore the woman. That’s why we have to give a part to death…Do not use vulgar words to talk about this (placenta)! When you say “koukan, e nan kan”, this means “we will cut the placenta”. But we do not cut… You want to take the part of death. So instead of saying “e nan kan” (…) we must find the subtler words. (Researcher, man, informal conversation)

I cannot accept that my wife is called in secret to raise awareness. Worse still, when these women go into consultation, they are given 20.000 CFA [35 USD] in secret, and they are now forced to join the project. It was the straw that broke the camel’s back. Our health centre has been closed for at least three months, and it is now that it started working. So, it’s like a conspiracy between midwives and pregnant women. If it’s like that, there’s enough to suspect bad intentions. (Community member, man, informal conversation)

The political involvement of CHWs

It means that the CHW also forget some things; man should not put many things in the nostrils; it will suffocate them, and yet: that’s their problems. I explain that to them because, politics spoils a lot of things. Politics spoils a lot of things. A lot, you cannot imagine. You have been chosen to prick pregnant women and to draw blood, and also to give medicine to children, and you put yourself in politics… There are people who have even said that vaccinators will not come to their homes because those are in the opposition and what will they [vaccinating agents] do in their homes? They will put strange things in their children’s mouths. (Village chief, man, interview)

Health system factors

The vaccinations we give to children are free things. We do not pay before making these vaccinations and yet, there are some people who refuse that because when children are vaccinated like that, they start having illnesses and parents spend a lot finding treatment; That’s why there are people who refuse things that are given for free… (Community member, man, group discussion)

Last time, vaccinators went from house to house to vaccinate my children. A few days later, these children all became ill. I took them all to the hospital to be cared for. I arrived in the centre, but no one was interested in us. They even told me to take my children home, that they do not even know where we got these diseases. I was really unhappy that day since it is they who sent us these agents to vaccinate our children. And why, if there is afterwards a problem, and we come to see them, they refuse to take us? We cannot accept these kinds of things. That’s why, if there is a project that comes, and we are not informed, we take our guard to not fall into their traps. (Community member, man, informal conversation)

In health centres, in maternity ward, what happens? It’s just like, since COSMIC people have invaded their work, their business does not work as before; I did not understand why; because there is a medicine there, that COSMIC people give to pregnant women free of charge. And this medicine is also available in health centres. It seems to me that they sell these drugs. (Village chief, man, interview)