Mpanje village is dotted with several brown brick huts and is about 150km from the Malawi capital Lilongwe. There are no tarred roads and the biggest town, Salima District, is 50km away. Eighty five percent of Malawi’s population, including women of child-bearing age live in rural settings like Mpanje, often far from equipped clinics and hospitals.
It is late afternoon, women have gathered outside the huts preparing the evening meal on a fire. A few dogs have sought relief from the heat in the shade, and children, running around.
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.
|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.
|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.
|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.
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.
Tannes Kalinda stands with the Chikondo Women’s group in the vegetable garden that they maintain to ensure that pregnant women in their community have enough nutrional food to eat during their pregnancies. CORNEL VAN HEERDEN / AL JAZEERA
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.
The Lifelines: the Quest for Global Health film “Between Life and Death” profiling maternal and neonatal health in Malawi will air on Al Jazeera English starting 15 May 2014.