Factors Influencing Women's Choice of Place Of Delivery in Rural Malawi- An Explorative Study

Line Seljeskog, Johanne Sundby, Jane Chimango


This explorative study was conducted in the Mangochi area in Malawi with the aim of investigating the individual, community and health facility level factors influencing women's choice of place of delivery. In depth interviews and non-participating observation were the methods used. Three major issues were revealed. First, sub optimal quality of care including communication, attitudes and cooperation within the health care system was identified as a main factor. Secondly, cultural aspects such as influence from decision makers, perceptions of danger signs and traditional views on pregnancy and delivery were important. Finally, an unsatisfactory availability to skilled delivery care in terms of distance, transport and costs was shown. We conclude that the barriers to use of professional obstetric care in Malawi partly can be attributed to the health care system itself, and that a more individualized maternity care is needed. (Afr J Reprod Health 2006; 10[3]:66-75)


Keywords: Maternal health Quality of care Place of delivery 

Full Text:



AbouZahr C and Wardlaw T. Maternal mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA, unedited version. UNICEF Statistics, 2003 http://www.childinfo.org/maternal mortality in2000.pdf.

Kowalewski M, Jahn A and Kimatta S.S. Why do at-risk mothers fail to reach referral level? Bafflers beyond distance and cost. African Journal of Reproductive Health 2000; 4:100-9.

Millennium Development Goals [http://ddp-ext.worldbank.org/ext/MDG/gdmis.do]

Government of Malawi, Malawi Demographic and Health Survey 1992, 2000. National statistic Office 1994, 2000.

Buttiëns H, Marchal B and De Brouwere V. Editorial: Skilled attendance at childbirth: let us go behind the rhetorics. Tropical Medicine & International Health 2004; 9:653-654.

Ronsmans C, Etard J.F, Walraven G, Hoj L, Dumont A, de Bernis L and Kodio B. Maternal mortality and access to obstetric services in West Africa. Tropical Medicine and International Health 2003; 8:940-948.

Malawi: Health Management Information Bulletin, December 2003.

Espo M. Infant mortality and its underlying determinants in rural Malawi. PhD thesis, University of Tampere, Tampere 2002, 49-52

Kulmala T. Maternal Health and pregnancy outcomes in rural Malawi. PhD thesis, University of Tampere, Tampere 2000.

Bergstrom S. Forlossningsvârd i U-land. Reklam & Katalogtryck, Uppsala 1988.

Safe Motherhood Project. The Confidential Enquiries into Institutional maternal deaths in the Southern Region of Malawi, 2001

Lawson J.B, Harrison K.A and Bergstrom S. Maternity care in developing countries, RCOG Press, 2001

Reproductive Health Unit, Ministry of Health and Population in Malawi, WHO. Malawi Obstetric Quality of Care Assessment, Draft report, 2003.

Jahn A, Carvalho I and Kalinga M.J. Evaluating traditional midwife training programs: lessons learned from Tanzania. International Journal of Gynecology & Obstetrics 2001, 73: 277-278.

Chain M, Sundby J, and Vangen S. Maternal mortality in the rural Gambia, a qualitative study on access to emergency obstetric care. Reproductive Helath 2005; 2(3)

Jahn A, Kowalewski M and Kimatta S.S. Obstetric care in southern Tanzania: does it reach those in need? Tropical Medicine and International Health 1998; 3: 926-932.

Caldwell B.K. Identification of unmet needs. Why women continue to die from childbirth in Dhaka, Bangladesh. Interregional seminar on reproductive health, unmet needs and poverty: Issues of access and quality of health, Bankok, Nov 2002.

Van der Broek N.R, White S.A, Ntonya C, Ngwale M, Cullinan T.R, Molyneux M.E and Neilson J.P. Reproductive health in rural Malawi: a population-based survey. BJOG: an International Journal of Obstetrics and Gynecology 2003; 110: 902- 908.

Kowalewski M, Mujinja P and Jahn A. Can mothers afford maternal health costs? User costs of maternity services in rural Tanzania. Aft JReprod Health 2002; 6: 65-73

Olsen B.E. Motherhood - a hazardous endeavour. Maternal deaths and urinary tract infections during pregnancy in rural northern Tanzania. PhD thesis, Center for International Health, University of Bergen 2002, Paper 3 and 4.


  • There are currently no refbacks.