Maternal and neonatal health in Malawi: An integrative literature review

Abstract

Background/Aims: A conservative estimate suggests women giving birth in Malawi are 14 times more likely to die giving birth than women in western nations. Despite attempts to address maternal and neonatal health, Malawi will not meet World Health Organization Millennium Development Goals 3, 4 and 5 for improving gender equity, reducing child mortality and improving maternal health by 2015. This integrative literature review looks through a social lens to view Malawi's progress towards meeting Millennium Development Goals 3, 4 and 5. Methods: A search was conducted using CINAHL, Google Scholar, Medline and Health Source online databases. Initial keywords included but were not limited to: gender bias; gender inequality; midwifery care; maternity; traditional birth attendants; skilled birth attendants; and social determinants. All searches included keywords with Boolean operator ‘and’ Malawi. Search filters were limited to publications dated from 2010 to 2015 and in English only. Additionally, reference lists from articles selected were reviewed, which led to further relevant sources. Although 48 articles were accessed, only 13 were considered to have high relevance, credibility and currency and were therefore included. Findings: Poverty underpins all social determinants of health and is the primary barrier to Malawi achieving the Millennium Development Goals. Poverty limits girls' access to education, which increases their risk of being exposed to infectious diseases. A lack of education is also associated with limited use of primary maternity care with a skilled birth attendant. Conclusions: Primary maternity care needs to be affordable and acceptable to Malawian women and provided close to their families and communities. The primary responsibility for this rests with Malawi's government, which should be encouraged to adopt supportive, enabling policies. To assist in this, western governments need to be socially responsible in deployment of their foreign aid and strategies to attract and retain skilled workers.