WUNRN
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Malawi - Rural
Communities, Women & Men, Are Creating New Ways to Save Mothers &
Their Babies Crystal
Orderson - 27 Apr 2014 |
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The
Chikondo Women's Group in Malawi are working to make pregnancy, birth and the
first months of life safer for the mothers and babies in their community. |
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A group of people has begun to gather outside one of the huts.
About three men and 10 women from the village are meeting to discuss how best
to supply pregnant women with nutritious food and ensure zero maternal and neonatal deaths in their village.
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The Chikondo Women's Group is one of close to 200 groups in the Salima District alone that are taking maternal health matters into their own hands. CORNEL VAN HEERDEN / AL JAZEERA
Historically,
it is not a conventional topic. But it is a very important one for this
village. Since the implementation of the Presidential Safe Motherhood
initiative in 2012, villages across Malawi are taking maternal and neonatal
issues seriously. It is this community spirit that has ensured the success of
the campaign in reducing the mortality rate in the country. Villages like
Mpanje are championing for change. And it all started with women’s groups that
took the lead on the issue.
Groups on
the increase
The
Chikondo Women’s Group is one of close to 200 groups in the Salima District
that are taking maternal health matters into their own hands. They have been
active for four years.
With the
help of the non-governmental organisation MaiKhanda, meaning
"mother-baby" in the local Chichewe language, villagers are
encouraged to create an understanding of maternal health issues and also to
lobby for support with training and advocacy.
"Culturally
women never had a say in birthing options. This was left to the men and village
elders or the in-laws. They had no voice at all," said Abigail Nyaka, a
programme officer from MaiKhanda.
The
organisation is assisting groups of men and women to be the eyes and ears of
the village and encourage safe birthing.
"The
women and men meet weekly, and they discuss issues pertaining to maternal
health issues and have been encouraged to have local men as members as
well," explained Nyaka.
Traditional
Birthing Attendants
According
to the United Nations, in 2000, the maternal mortality rate was estimated at
840 per 100,000 deaths. Some have attributed this to women not accessing
hospitals and instead opting to give birth in rural villages like Mpanje, with
no help from a doctor, midwife or local health centre. If there was an
emergency, the women and babies would inevitably die. In the past, traditional
birthing assistants, also known as TBAs, did the work of a midwife.
As women
begin labor, they would be taken to a TBA in the village to assist them in giving
birth. The TBA would not necessarily be trained or have the necessary
medical resources to assist women during birth.
Tannes
Kalinda is a former TBA and is now the chairperson of the Chikondo women’s
group. The 66-year-old grandmother said she started as a TBA in the 1970s, and
delivered close to 200 babies, but she also had several women die in her care.
Malawi
President Joyce Banda’s bold plan to make TBAs illegal put an end to an old
tradition in rural Malawi, where the majority of people live, banning these
women who were unequipped and ill prepared to assist pregnant mothers give
birth.
Kalinda
is now advocating that women be actively involved in maternal health and make
use of midwives.
According
to MaiKhanda, the government banned the use of TBAs in 2008, but no provisions
were made for alternative home-based delivery. With the help of women’s groups,
NGOs, and elders like Kalinda, women are encouraged to deliver at health
facilities.
"Women
were dying, and we didn’t know what to do. Now we refer women to hospitals and
there have been no deaths," said Kalinda in her local language of
Chichewa.
Women are
now advised to go the nearest health centre about two weeks from giving birth.
In some cases, villagers even escort some pregnant women on boats or cars to a
health centre. In this way, the women are able to be access the necessary
health care when giving birth.
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Traditional Authority Maganga,
chief of the Yao Tribe, has supplied a boat to help mothers of the region
cross a river free of charge. They identified this as a big obstacle as it
hindered mothers from getting to the local medical centre. Here a mother
loads her bicycle, her baby and herself onto the boat for a late afternoon
crossing on her way home. CORNEL VAN HEERDEN / AL JAZEERA |
Traditional
chiefs part of the solution
But
banning TBAs was not the only solution in reducing maternal and neonatal
deaths. In a country where 20,000 traditional chiefs play a powerful role, it
was crucial to bring this constituency to the table.
In
another bold move, President Banda appointed the powerful Chief Mac Julio
Kwaitane as the chairperson for a new programme, the Presidential Initiative on
Maternal Health & Safe Motherhood. That health initiative has focused on
reducing maternal mortality from its current rate, to 115 or less per 100,000
live births, and has aimed to do it by 2015. Tribal chiefs get trained in the
importance of clinic birth for rural women, while recognizing that their
influence will largely determine what kinds of health-care options are
available to women.
The chief
has been championing the maternal health cause and has brought with him
thousands of village chiefs who hold power in villages across the country.
"Traditional
chiefs are the gatekeepers in our society. They get respect and everyone
listens to them. Their involvement in safe birthing means people listen and
follow their advice," said MaiKhanda’s Nyaka.
"If
women fail to do this, we fine them," said Chief Isaiah Nkhundi.
Chief
Nkhundi has eight villages, including Mpanje, under his authority and
traditional leaders like Nkhundi play a powerful role in the community. In
consultation with women’s groups and also men, the chiefs have encouraged women
to deliver at local health centres.
"As
a village chief I had to bury too many women and babies. Now this no longer
happens and I can spend my time developing the eight villages under my
authority," he said.
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Chief Isaiah Nkhundi meets with a
group of men to discuss local projects to advance maternal and neonatal
health in the village. CORNEL VAN HEERDEN / AL JAZEERA |
According
to research by MaiKhanda, the efforts by village chiefs and local communities
have resulted in a 30 percent increase in deliveries at health facilities.
Since the
establishment of the women’s group in the area in 2010, they have also started
other projects like local food gardens. Women's groups have been encouraged to
start food gardens in order to provide nutritious vegetables like spinach and
Chinese cabbage to pregnant mothers.
Food
Gardens
In Mpanje
the women start their day at five in the morning. They walk about 5km to the
river to work on their patch of crop. Kalinda says providing vegetables to
women have been a lifesaver.
Malawi is
one of the poorest countries in sub-Saharan Africa, and according to the Malawi
Demographic and Health survey, about 39 percent of the population lives below
the poverty line.
Providing
much needed vegetables from Kalinda’s women’s group ensures healthy mothers and
babies. The women’s group sees to it that pregnant women receive vegetables so
that their nutritional needs are met.
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Men’s
involvement
Like many
countries in sub-Sahara Africa, Malawi is a highly patriarchal society and men
make the decisions in the home. In the past they would also decide the birthing
option for their wives.
Gender
activists say including men in the women's groups should be encouraged. This
allows men to talk about maternal and neonatal health options and to become
part of the solution. The 37-year-old Syfford Time is a father of four, and
said it was important for him to join the Chikondo Women’s Group.
"We
wanted to prevent the death of women and children in our village."
Time says
the women's groups have been good for the community.
"We
do not want women to give birth at home and encourage them to go to local
health centres."
And most
importantly, said Time, they have encouraged other men to join the women’s
group and ensure maternal health is a community issue and not left in the hands
of one man or a woman only.
It is in
small villages like Mpanje where change is happening and where community elders
and villagers are taking the maternal health issue into their own hands.