Kong Transcultural fund recipient
Summer 2002, Malawi

A Save the Children Federation/US Project:
Formative Research on Birth Planning in Balaka district, Malawi
June 9, 2002 - August 15, 2002

The overall purpose of my research study was to identify socio-cultural factors that may have an impact on the development and utilization of birth plans. Using qualitative research methods (4 focus group discussions and 8 in-depth interviews), the main research question examined was: "Can individual birth plans be promoted in a culturally sensitive manner to improve maternal health especially regarding appropriate care-seeking during antenatal, delivery, and postpartum periods?"

First, I developed interview guides for focus groups and in-depth interviews, which were translated into the local language (Chichewa), pre-tested, and revised as necessary. The next step was to identify, hire, and train team members, including a facilitator, interviewer, translator and transcriber. After random selection of 4 villages in Balaka district, participants (mothers with at least 2 children) were conveniently sampled by each village headman.

Preliminary analysis of the data collected are highlighted as follows:

· Hierarchical order in which pregnancy is disclosed to others - husbands told first, then mothers, grandmothers, and possibly other relatives
· Some of the traditional beliefs and practices include:

· Husbands play a crucial role in all aspects of decision-making for maternal care
· Most important preparations for birth are material goods for mother and baby (e.g., cloth pads and chitenjes - cloths to wrap baby), usually starting at 7th or 8th month
· Making plans for birth deemed "impossible" because unpredictable and of "God's will"
· Abortion, although illegal, is becoming commonplace within the communities

Based on these initial findings, key recommendations may include:

· Conduct qualitative research with key decision-makers to understand dynamics of decision-making process
· Establish amayi (mother) clubs as a support mechanism and maternal health education for pregnant women
· Promote formal emergency transport system at village level
· Promote behavior change communication efforts via radio, village health committees, health surveillance assistants, and mother clubs
· Encourage maternity waiting homes
· Train TBAs on danger sign recognition in mother and newborn and discourage harmful traditional practices

Working with the Balaka field office of Save the Children offered me the opportunity to experience firsthand the operations of such an organization on the ground, from their successes to their challenges. By being part of the formative research process, I was able to examine the socio-cultural context of maternal health problems in Malawi and to understand safe motherhood initiatives and their implications for project planning, implementation, and evaluation in a country with high maternal mortality and morbidity. I was also able to better understand the needs of the community, how they are dealing with and taking initiatives on important health issues such as maternal health, and how roles of external assistance can have a positive impact on the community. This experience not only enhanced my professional growth but personal growth as well through special friendships made with people in Balaka. My experience this summer was an invaluable one and I came to know why Malawi is nicknamed the "warm heart of Africa."

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