Exploring community support on safe motherhood: A case of Lilongwe District, Malawi.

BACKGROUND: Malawi is grappling with a high maternal mortality of 439 per 100 000 live births. It is estimated that 80% of maternal deaths can be prevented by actively engaging the community in the country. However, community support on safe motherhood remains unknown. AIM: This study, therefore, explored community support rendered to mothers and babies during antenatal, intrapartum and postpartum periods. SETTING: This study was conducted in the Lilongwe District, Malawi. METHODS: This was a qualitative study that collected data from 30 village health committee members through Focus Group Discussions (FGDs). Data were analysed using thematic analysis. RESULTS: This study found that community support on safe motherhood rendered to women varied. The following five themes emerged from FGDs data on community support on safe motherhood: antenatal support, intrapartum support, postpartum support, bylaws reinforced by chiefs in the community and safe motherhood support groups. Community members encourage pregnant women to attend antenatal care, escorted pregnant women to the hospital for delivery and assisted women to care for a child and go for postpartum checkups. Community bylaws were considered as a necessary tool for encouraging women to attend antenatal care, deliver at the health facility and attend postpartum checkups. CONCLUSION: This study suggests that community members play a crucial role in providing support to women and newborns during antenatal, intrapartum and postpartum periods.

Contraceptive unmet needs in low and middle-income countries: A systematic review.

Contraceptive use in sub-Saharan Africa remains low, with a minimal rise from 23.6% to 28.5% between 2008 and 2015. Unmet needs for contraception remain a public health concern in low and middle-income countries. The objectives of this systematic review were to explore the perceptions of women and men accessing family planning services; and the perceptions of healthcare professionals delivering family planning services in low and middle-income countries. Literature search was limited to studies published in English in the period from 2000 to 2017. Thirty studies included in this review were identified from CINAHL, BNI, EMBASE, PsycINFO, MIDIRS and MEDLINE databases. A narrative synthesis, was adopted to synthesise the findings. Findings indicate a lack of awareness of contraception amongst women and men. Experienced and perceived side effects of contraceptives influence contraceptive continuation and discontinuation. Evidence from this review points to the need for awareness of contraception to dispel myths and misperceptions regarding modern contraception.

Experiences of women, men and healthcare workers accessing family planning services in Malawi: A grounded theory.

BACKGROUND: The importance of modern contraceptive methods in averting unwanted pregnancies has been acknowledged in Malawi. Currently, the country has registered the highest rates of unsafe abortions, unmet needs for contraception and a low contraceptive prevalence rate. Understanding why these rates exist is important. However, women's views and experiences regarding uptake of family planning methods in Malawi have not been explored. METHODS: A grounded theory methodology was used. Data were gathered through in-depth interviews with women (n = 18), men (n = 10), healthcare workers (n = 10) and non-participant observations of family planning clinic consultations (n = 10). Data were analysed using constant comparative technique. Methods of open, axial and selective coding enabled subsequent conceptualisations until theoretical saturation occurred. RESULTS: The core category 'disenabling environment prevents women's family planning needs from being met' provides an understanding of women's, men's and healthcare workers' experiences of contraceptive use and non-use. The disenabling environment contributed to shaping women's family planning experiences. This was supported by three main categories: navigating the processes, disempowerment of women and learning by chance. CONCLUSION: Findings from this study illuminate contextual issues into how women, men and healthcare workers experience family planning use and non-use in Malawi. A multifaceted strategy is required to support a woman's family planning needs. At community level, awareness and education of family planning methods is required to actively inform all people in society so that they support a woman's family planning needs. At national level, laws that would empower women with decision-making ought to be developed and enforced.

Assessing the quality of postnatal care offered to mothers and babies by midwives in Lilongwe District.

BACKGROUND: The quality of care received by mothers and newborns in low-resource settings is often poor. This may partly explain the high rates of maternal deaths (60%) that occur during the postpartum period in Malawi. However, the quality of care provided to mothers and newborns in the country has not been adequately assessed. Therefore, this study aimed at assessing the quality of postnatal care services offered to mothers and babies by midwives in Lilongwe District. METHODS: This was a quantitative study that used a sample of 58 midwives to assess the quality of postnatal care at three selected health facilities. A structured questionnaire, an observation tool and a facility checklist were used to collect data. Descriptive statistics were used to analyse the data. The study received ethics approval from the relevant authority. RESULTS: The study found that the percentages reported by midwives regarding client monitoring varied and were below the 80% threshold. Midwives did not always follow the reproductive health standards on client examination so that less than 75% of midwives inspected perineal wounds (52.2%), checked vital signs of neonate (66.7%) and mother (62.2%), and inspected lochia drainage (30.4%). Most midwives (91.3%) never assessed the emotional state of the mother. Midwives covered a range of topics during health education and counselling. However, some topics, including immunisations (31.1%), were never taught. CONCLUSION: The study has suggested that the postnatal care offered by midwives at three health facilities was generally substandard and midwives do not always monitor, assess and counsel postnatal clients.