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

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.