Social inequalities in survival and therapeutic pluralism in the face of breast cancer in Côte d'Ivoire

Abstrac: In Côte d’Ivoire, breast cancer continues to be characterised by late diagnosis, high mortality, and pronounced social inequalities in survival. One central yet insufficiently explored dimension concerns the ways in which patients move across multiple therapeutic circuits hospitals, community networks, traditional medicine, and self-care practices. Far from constituting a mere accumulation of options, this plurality is embedded in socially situated strategies shaped by economic resources, family norms, and culturally grounded representations of illness. These hybrid trajectories frequently delay access to biomedical care, undermine therapeutic continuity, and widen disparities in outcomes. Drawing on a qualitative approach combining in-depth interviews and direct observation within both biomedical and popular settings, the study brings to light parallel care pathways that are often poorly coordinated. Patients alternate between biomedicine, phytotherapy, prayer, and self-medication in a quest for reassurance or more accessible solutions. These forms of arbitration, structured by social inequalities, are accompanied by breaks in care resulting from financial exhaustion, adverse treatment effects, or familial pressures, leading to fragmented care and worsening prognoses. Overall, the findings point to a hybrid health system devoid of effective mechanisms for coordination across therapeutic spheres, thereby disproportionately exposing the most vulnerable patients. Reducing inequalities in survival therefore requires acknowledging these plural care itineraries and strengthening provider patient communication, cultural mediation, and institutional bridges between biomedical and community-based actors.