Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/29438
Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
Title: Weighing the options for delivery care in rural Malawi: community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants
Author(s): Uny, Isabelle
de Kok, Bregje
Fustukian, Suzanne
Contact Email: isabelle.uny@stir.ac.uk
Keywords: Policy analysis
policy implementation
maternal health
Malawi
traditional birth attendants
rural health
community care
skilled birth attendance
childbirth
Issue Date: 1-Apr-2019
Citation: Uny I, de Kok B & Fustukian S (2019) Weighing the options for delivery care in rural Malawi: community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants. Health Policy and Planning, 34 (3), pp. 161-169. https://doi.org/10.1093/heapol/czz020
Abstract: To address its persistently high maternal mortality, the Malawi government has prioritised strategies promoting skilled birth attendance and institutional delivery. However, in a country where 80% of the population resides in rural areas, the barriers to institutional deliveries are considerable. As a response, Malawi issued Community Guidelines in 2007 that both promoted skilled birth attendance and banned the utilization of traditional birth attendants for routine deliveries. This grounded theory study used interviews and focus groups to explore community actors’ perceptions regarding the implementation of this policy and the related affects that arose from its implementation. The results revealed the complexity of decisionmaking and delivery care-seeking behaviours in rural areas of Malawi in the context of this policy. Although women and other actors seemed to agree that institutional deliveries were safer when complications occurred, this did not necessarily ensure their compliance. Furthermore, implementation of the 2007 Community Policy aggravated some of the barriers women already faced. This innovative bottom-up analysis of policy implementation showed that the policy had further ruptured linkages between community and health facilities, which was ultimately detrimental to the continuum of care. This study helps fill an important gap in research concerning maternal health policy implementation in LICs, by focusing on the perceptions of those at the receiving end of policy change. It highlights the need for globally promoted policies and strategies to take better account of local realities.
DOI Link: 10.1093/heapol/czz020
Rights: This item has been embargoed for a period. During the embargo please use the Request a Copy feature at the foot of the Repository record to request a copy directly from the author. You can only request a copy if you wish to use this work for your own research or private study. This is a pre-copyedited, author-produced PDF of an article accepted for publication in Health Policy and Planning following peer review. The version of record Uny I, de Kok B & Fustukian S (2019) Weighing the options for delivery care in rural Malawi: community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants. Health Policy and Planning, 34 (3), pp. 161-169 is available online at: https://doi.org/10.1093/heapol/czz020

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