264922 Mobilization for maternal health through village savings and loan associations in rural central Malawi

Monday, October 29, 2012

Loren W. Galvao, MD, MPH , Center for Cultural Diversity and Global Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Patricia E. Stevens, RN, PhD , College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
Esther Saka, Diploma Public Relations , CARE International in Malawi, CARE, Lilongwe, Malawi
Thula Saka, Diploma Rural Development , CARE International in Malawi, CARE, Lilongwe, Malawi
Chrissie Depete, Diploma Rural Development , CARE International in Malawi, CARE, Lilongwe, Malawi
Lucy Mkandawire-Valmu, PhD, RN , College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI
Katarina Grande, MPH , Department of Population Health Sciences, University of Wisconsin-Madison Population Health Institute, Madison, WI
Lance S. Weinhardt, PhD , Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
Background: Malawi's maternal mortality rate is among the highest in the world. Improving childbirth safety in resource-limited countries requires innovative structural interventions. Methods: Within a 5-year, mixed-methods, quasi-experimental study in rural central Malawi, we investigated how Village Savings and Loan Associations (VSLA) affected birth practices. We purposively sampled VSLA members (60 women / 30 men) for 90 in-depth interviews and 9 focus groups analyzed thematically. Results: Participation in VSLA mobilized individuals to improve childbirth safety in tangible ways. Loans obtained early purchased transport to antenatal visits and supplies for hospital births. Ahead of labor, women and accompanying female family members traveled to faraway health care facilities and “camped” there for days or weeks until delivery. VSLA cash secured care for children left at home, and covered costs of residing at hospital. Many women still delivered at home, however, when they could not be spared from household responsibilities for such lengthy periods, or because influential men objected to births outside the village. Families' cultural ties to traditional home births and trepidation about western medicine also kept women from professional obstetric services. If childbirth complications arose, the critical issue became transport to hospital. Emergency VSLA loans paid for precious conveyance via bicycle, ox cart, or ambulance. Conclusions: Localized microfinance affords responsive, time-sensitive decisions by trusted neighbors who understand financial pressures associated with maternal health in rural environments. By building capacity for saving at the village level, VSLA provide an economic safety net to respond to routine as well as emergent obstetric needs.

Learning Areas:
Implementation of health education strategies, interventions and programs
Public health or related education
Public health or related nursing
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. List three reasons why village saving and loan associations (VSLA) helped women in this study area in rural Malawi to access routine and emergency obstetric services. 2. Identify three major barriers that women face to access routine and emergency obstetric services in the study area in rural Malawi. 3. Define what is an structural community-based economical intervention approach and how it help mobilizing women for addressing maternal health issues and barriers to care in rural Malawi.

Keywords: Maternal Health, International MCH

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Co-Principal Investigator in this 5-year R01 NIH-funded project in Malawi. I have been principal or co-principal investigator of multiple federally funded and foundation grants focusing on HIV prevention, maternal and reproductive health. My scientific interests recently have been on evaluating the impact of structural interventions (economical, agricultural and educational interventions)on HIV, maternal & child health and reproductive health outcomes, in less developed countries.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.