Why Do Malawians Birth at Home?

Nearly 200 babies have been born in Child Legacy’s health center! Getting to check in on the CLI Facebook page brings me lots of pleasant surprises. There’s so much going on there, it’s amazing to see the speed of their growth in healthcare, agriculture and clean water access. The HSAs bring basic medical services out to the communities, and I spy a couple of my community volunteers in this photo!

Child Legacy mobile clinics. See more photos like this on their Facebook: https://www.facebook.com/childlegacyinternational/
A Child Legacy mobile clinic. See more photos on their Facebook page

Meanwhile, the research team has been dedicating a lot of time to the maternal and neonatal death audit over the last couple of weeks. It always feels good to see those 4 a.m. messages in my inbox.

Recently the team has followed up on four more neonatal deaths, held a community volunteers meeting, and gathered as a M&NDA committee, which has been in the works for many months but difficult to pull off with the turnover and other project work on their plates.

One of the most insightful pieces I’ve heard from the group is feedback on why women so often deliver at home. A significant proportion of the neonatal deaths we recorded occurred after a delivery outside of a hospital or other health facility. The research team asked the community for their insights, (which I LOVE–what better way to engage our volunteers than giving them a platform to provide their expertise and have a stake in the solution?). Here are the notes from that meeting:

We had to look at reasons why people don’t come to the hospital on time sometimes not even coming to the hospital when labor starts (these are the reasons which people can not confess themselves)

Then we observed that:

1. In a lot of women, it is just in their mind that to deliver at the hospital is no better than delivering at the TBA, nothing else.

2. Some women met cruel nurses in the hospitals and they don’t have a willing to go again to the hospital when they are in labor, TBA’s takes good care of them. (They gave some scenarios)

3. Unnecessary confidence. They are confident that they are much experienced with how labor goes and see going to the hospital as waste of time.

4. Other old women mislead young women, because they had 8 children all delivered at home or TBA without any problem, they discourage their children to go the facility for delivery and they want to conduct deliveries at home.

5. Laziness, other women are just lazy to act fast/on time, as a result others are even delivering in the bathroom outside the homes alone.

SO INTERESTING. So many opportunities for new research and continued work. I could unpack these notes alone for days.

I had to smile at the comment about ‘laziness’ — let’s be real. If I had to pay three day’s worth of my own pay, to ride over giant potholes on an ox cart for hours in active layer with no meds, I’d probably choose the person who birthed me and would come to me in my home.

It’s funny to consider how natural home birthing is kind of bourgeois in the West, where medicine is advanced enough to have skilled midwives who can handle a low-risk delivery pretty much anywhere. But Traditional Birth Attendants like those in Malawi are a different story. Finding a way to respect cultural practices and integrate safe medical practices (like standards around sterility) is vital in addressing this issue. And it needs addressed–in one neonatal death case, a TBA directed a mother to withhold from feeding her newborn because the baby was premature. Quite the opposite from what the child needed.

Birthing without a skilled labor attendant is one clear obstacle that we can definitely address in the Msundwe community. The question is how. I’m really looking forward to visiting with my team again in August to take the next step in improving care for these families. !

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