Citation Uny I (2018) Weighing the options for delivery care in rural Malawi: community perceptions of the 2007 policy promoting facility deliveries and banning traditional birth attendants.. BSA 50th Anniversary Medical Sociology Annual Conference, Glasgow, 12.09.2018-14.09.2018.
Abstract To address its high maternal mortality, the Malawi government has prioritised skilled birth attendance. However, in a country where 80% of the population resides in rural areas, there are tremendous barriers to institutional deliveries. Historically, rural women have relied also on Traditional Birth Attendants (TBAs) for their childbirths. However, in 2007, Malawi issued Community Guidelines promoting skilled birth attendance and banning TBA utilization. I will present a grounded theory study which used interviews and focus groups to explore community actors’ perceptions of the implementation of this policy (men, women, village headpersons, TBAs). Findings indicate that although community actors agreed that delivering at facilities may be safest when complications occur, this did not necessarily ensure their compliance with a policy they perceived as authoritarian and prescriptive. Moreover, the policy’s implementation aggravated some of the barriers rural women already faced. Issues of disrespectful care at facilities also partly led women towards non-compliance with this policy. By conducting an innovative bottom-up policy implementation analysis, this study demonstrated that the policy led to a rupture of linkages between TBAs and skilled birth attendants (SBAs), which was detrimental to the continuum of delivery care. This study helps fill an important gap in research concerning maternal health policy implementation in LICs, by focusing on the perceptions of those at the receiving end of policy change. The theory developed accounted for the interplay of intrinsic and extrinsic factors which weigh into rural women's delivery care decision making, within the constraint of this new policy.
ISSN of series
BSA 50th Anniversary Medical Sociology Annual Conference