Women’s groups’ perceptions of maternal health issues in rural Malawi

Progress in preventing and seeking care to reduce maternal deaths in rural Africa depends on women’s and communities' knowledge and attitudes to maternal health. Research has shown that women individually have little knowledge of maternal health problems. What are the perceptions of women’s groups in rural Malawi and what are the implications for strategies to reduce maternal mortality?

Malawi has one ofthe highest maternal death ratios in the world (984 deaths per 100,000 livebirths). Women have on average six children and only slightly more than half ofall births are assisted by a skilled attendant or take place at a healthfacility. As most births and maternal deaths occur at home, behaviour at the villageand community levels, especially the seeking of timely and appropriate care, cansignificantly affect maternal mortality.

Interventions thatstir communities into action have successfully improved neonatal health. Thesuccess of such interventions to decrease the number of maternal deaths hingeson an understanding of women’s perception of the health problems theyexperience. This knowledge could be useful in developing more successfulinterventions, especially in rural Africa, where women’s concerns are largelynot heard and not taken into consideration by community leaders andpolicymakers.  

A study conducted by MaiMwana Project (Mchinji,Malawi) in collaboration with the Institute of Child Health (London, UK) looksat the perceptions of 172 groups made up of 3,171 women in the rural districtof Mchinji in Malawi. The women were asked about the maternalhealth problems they experience and which issues they feel are most important.These findings have implications for strategies to improve preventive andcare-seeking behaviour and reduce maternal deaths.

The study findsthat:

• Morethan half the women’s groups commonly identified the following maternal healthproblems: anaemia (87 percent), malaria (80 percent), retained placenta (77percent), obstructed labour (76 percent), malpresentation(71 percent), antepartum and postpartum haemorrhage (both 70 percent) and pre-eclampsia (56 percent).
• They prioritised five problems as the most important: anaemia(sum of rank score 304), malpresentation (295),retained placenta (277), obstructed labour (276) and postpartum haemorrhage (275).   
• HIVand AIDS and sepsis received a much lower ranking as they were not given dueconsideration because of their relative complexity and the context within whichthey occur.

Within thediscussion groups, the women developed a greater awareness of maternal healthproblems and they became motivated to move from identifying and prioritisingproblems to addressing them. The research suggests that:

• Strategiesthat mobilise people within communities can draw onpeople’s collective ability to identify and solve problems and can help tackleserious health issues such as high maternal deaths.   
• Increasingpeople’s knowledge and changing their attitudes is needed in order to improvepreventive and care-seeking behaviour.
• Women’sperceptions of their problems could be exploited as a vital resource forcommunities and policymakers.
• Ruralwomen in Malawi have an in-depth understanding of their maternal healthproblems and can make a significant contribution to finding solutions to theextensive issues associated with pregnancy in Africa.