A Road Map for Maternal Care: Malawi

Every year, hundreds of thousands of women’s lives are put at risk to give birth, but this ordinarily beautiful and transformative experience is especially terrifying in sub-Saharan Africa. Malawi, a small country in this part of the world, is overwhelmed by poverty and disease, which impact maternal and infant mortality rates. With a high fertility rate of 5.47 births per women, Malawi is seeing too many of its mothers suffer the dangerous process of pregnancy and birth. In fact, it is considered unlucky to tell people that you are pregnant because child-bearing is viewed as such a serious health risk. However, prospects for expecting mothers in Malawi have improved greatly ever since the country developed a maternal and newborn health program. Examining Malawi’s approach toward reducing mortality rates can offer invaluable ideas for other impoverished country struggling with poverty and disease.

Malawi is one of the first African countries to have developed a road map for maternal and neonatal health, which helps to focus and implement ways to improve health services. Written in 2005, the Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity in Malawi contains nine key strategies to guide the fiscally-responsible toward attaining the UN Millennium Development Goals for maternal and neonatal health. It aims to increase the availability, accessibility, and quality of skilled obstetric care during pregnancy, childbirth, and after delivery. Another key point of the document is its emphasis on empowering individuals, families, communities, and the government to improve maternal and neonatal health at different levels, thus increasing participation and involvement. Usually, countries with extremely high mortality rates have governments that neglect maternal and child healthcare or divert designated funds for corrupt purposes. Malawi’s road map makes it stand out from other sub-Saharan countries because it commits a larger part of its fiscal budget to healthcare, prioritizes maternal care, and focuses on delivering healthcare to rural areas.

Poor Malawian mothers and their newborns are more likely to survive because of the government’s commitment to maternal care. In order to stop death during childbirth, more women give birth under the supervision of skilled health providers that are equipped to recognize and handle complications. Trained birth attendants have replaced traditional birth attendants; even in the poorest areas of the country, 63% of births are attended by a qualified birth attendant. The rural areas also receive additional focus in maternal care, as many rural women of child-bearing age live far away from equipped clinics and hospitals. The Malawian government pledged to build as many as 150 maternal waiting homes where rural women can be under medical supervision as their delivery dates come closer. As a result, institutional delivery from 2009 to 2013 was around 73%. In the same time period, 95% of women had at least one antenatal checkup, 46% of women had at least four antenatal checkups, and 84% of women receive postnatal care within two weeks after delivery. The amount of coverage in maternal care is astounding considering Malawi is a predominantly rural country.

MaiKhanda, translated into “Mother and Baby”, is a program that mobilizes communities to improve quality of maternal care and increase awareness about maternal health. It has a proven success rate – in areas where MaiKhanda worked with communities and health facilities simultaneously, more than 1,000 newborn lives were saved. Part of the lasting success of MaiKhanda is attributed to its focus on reaching out to traditional community leaders and men. As explained by Ros Davis, Chief Executive of one of MaiKhanda’s partner for community outreach, “If there isn’t buy-in from the traditional leaders within the villages, then it’s very hard to get things going.” It manages to defy ingrained cultural assumptions and religious beliefs about pregnancy and giving birth while still respecting a heavily-patriarchal society. Most husbands are apprehensive about letting their wives travel far distances and be gone for a long time in order to give birth in a hospital because they are mistrustful and suspect that she may be seeing others. Another damaging assumption about birth is that only God will protect them, and the hospital can’t help in any way. By mobilizing traditional community leaders and educating men, MaiKhanda empowers women to make safer decisions about childbearing and gives them more confidence to seek out quality maternal care.

Malawi had one of the worst maternal mortality rates worldwide just a few years ago, but a coordinated dedication to maternal care has helped to reverse the trend and make Malawi a safer place for women to give birth. Although Malawi is still a long way from reaching globally-acceptable maternal mortality rates, it has outpaced its sub-Saharan counterparts in reducing maternal mortality. The emerging vibrant maternal health system in Malawi offers hope for other countries – if Malawi can do it, other countries can, no matter how insurmountable the obstacles may seem.

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