Over 98% of all women who die from complications in childbirth live in developing countries, and half of these are in sub-Saharan Africa. For a long time Malawi languished at the bottom of these grim league tables but now the prospects are more positive
Pregnancy is such a dangerous time in a Malawian woman’s life that it is considered unlucky to tell people about it.
- In 2008, Malawi had one of the highest rates of maternal mortality in the world with 1,100 maternal deaths for every 100,000 live births.
- The newborn death rate was also tragically high. In Malawi 29 out of every 1,000 babies died in the first 28 days of life, compared with three in every 1,000 in the UK.
- This means that, each year, nearly 21,000 mothers lose their babies when they have barely begun to live.
The prospects have improved since Joyce Banda became President of Malawi in April 2012. She has promised to promote maternal and newborn health and has shown a personal interest in the work of Women and Children First.
Malawi is one of the first African countries to have developed and costed a Road Map for maternal and neonatal health.
Women in rural areas often live in scattered villages a long distance from health facilities. This makes it difficult to communicate and organise at a local level to give women access to the information they need so they can make decisions on behalf of themselves and their children.
At the same time, a lack of resources means that health facilities are often struggling to provide services that can save lives.
Women and Children First supports both the Road Map and the achievement of Millennium Development Goals (MDGs) 4 and 5 using a three-pronged approach.
- Through participatory women's groups , we reach and mobilise communities to address the issues that affect maternal and newborn health.
- We work to strengthen and improve the quality of health services.
- We build the capacity of our partners to advocate at local and national levels.
A recent research has shown that this combined approach can reduce the newborn mortality rate by nearly a quarter. The overall analysis of the results showed that women’s groups can reduce maternal mortality by up to 55% in certain conditions, but we have not yet achieved sufficient coverage to demonstrate this level of improvement in our work in Malawi.
In Malawi, Women and Children First works with two community-based programmes covering four districts.
1. MaiKhanda (which means MotherBaby)
The MaiKhanda Trust is a maternal and newborn health NGO which works in three districts – Kasungu, Lilongwe and Salima. It supports both the community and the health system so that together they can play an active part in achieving better health and saving lives.
Women and Children First supported the project team in establishing participatory women’s groups in 805 villages – the largest intervention of its kind in Africa. The groups identified the maternal and newborn healthcare problems they face in their communities and worked to overcome them through low-cost solutions, which they themselves have devised and put into action.
In the areas where the community was mobilised through women's groups, the deaths of babies just before, during or after birth (perinatal mortality) fell by 16%. Where this work was combined with improving the quality of care at health facilities, newborn deaths fell by 22%.
The women's groups devised low-cost, achievable strategies to improve the health and prospects of mothers and babies. These included:
- growing iron-rich vegetables
- purchasing bicycle ambulances
- obtaining bed-nets to prevent malaria
- voluntary testing and counselling for HIV and Aids.
The groups were given help to evaluate their strategies and decide what to do next. Some of the groups continued to meet and to train one member to facilitate meetings so that the original facilitators would be free to establish new groups in other villages.
Women and Children First and MaiKhanda have begun planning for three new projects, and we are working hard to secure funding for this vital new work.
2. Maternal and child health in Ntcheu
Women and Children First worked in partnership with the Malawi Ministry of Health in the district of Ntcheu from 2005. In early 2010 we successfully concluded a programme with 86 women’s groups , which laid the groundwork for a five-year programme funded by Comic Relief
This project continues the collaboration with the Ministry of Health in Ntcheu District, covering a population of 82,000. It has set up 144 women’s groups and is establishing men’s groups to encourage greater male involvement.
Building on the foundations laid by the earlier work, the project is continuing and is working to:
- improve maternal and child health practices in the community
- raise the quality of health services for pregnant women and their children.
- implement a low cost system for collecting data to support the planning of health services
- establish an informal referral service to ensure that skilled care can be provided when it is needed.
As a result of our work with our partners:
- traditional leaders and other community members are championing improvements in maternal, newborn and child health.
- more women receive postnatal care promptly – an improvement from 4% to 84% attending within two weeks of delivery – a key factor in helping to keep mothers and babies safe and well.
- the proportion of births in health facilities has risen from 77% to 90%, with 95% of births being attended by skilled personnel.
The success of the work was captured when Comic Relief and a BBC crew filmed the project for Red Nose Day in March 2013.
The Village Volunteers Project in Kanyemba is a shining example of how this works in practice.
Success Story. It’s more than a year since the last neonatal death in Kanyemba village – a measure of the success of the Village Volunteers Project in Ntcheu.
Research and funding
There are reports on research into the lifesaving work done by Women and Children First and our partners in Malawi at:
The Big Lottery Fund (BIG) funded the work in Ntcheu from 2005 – 2008, and Women and Children First supported it with trust funding from 2008 – 2010.
Comic Relief has funded a five-year programme in Ntcheu.
What you can do
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BBC Radio 4 Appeal – Sunday 8th DecemberKathy Lette, bestselling author, writer, social commentator and Patron of Women and Children First, presents our BBC Radio 4 Christmas Appeal.
The Appeal will was broadcast on Radio 4 at 07.55 & 21.26 on Sunday 8 December 2013, repeated Thursday 12 December at 15.27. Please listen to the Radio 4 appeal or donate direct to us.