Intergenerational impacts of maternal mortality: Qualitative findings from rural Malawi

Abstract

BackgroundMaternal mortality, although largely preventable, remains unacceptably high in developing countries such as Malawi and creates a number of intergenerational impacts. Few studies have investigated the far-reaching impacts of maternal death beyond infant survival. This study demonstrates the short- and long-term impacts of maternal death on children, families, and the community in order to raise awareness of the true costs of maternal mortality and poor maternal health care in Neno, a rural and remote district in Malawi.MethodsQualitative in-depth interviews were conducted to assess the impact of maternal mortality on child, family, and community well-being. We conducted 20 key informant interviews, 20 stakeholder interviews, and six sex-stratified focus group discussions in the seven health centers that cover the district. Transcripts were translated, coded, and analyzed in NVivo 10.ResultsParticipants noted a number of far-reaching impacts on orphaned children, their new caretakers, and extended families following a maternal death. Female relatives typically took on caregiving responsibilities for orphaned children, regardless of the accompanying financial hardship and frequent lack of familial or governmental support. Maternal death exacerbated children’s vulnerabilities to long-term health and social impacts related to nutrition, education, employment, early partnership, pregnancy, and caretaking. Impacts were particularly salient for female children who were often forced to take on the majority of the household responsibilities. Participants cited a number of barriers to accessing quality child health care or support services, and many were unaware of programming available to assist them in raising orphaned children or how to access these services.ConclusionsIn order to both reduce preventable maternal mortality and diminish the impacts on children, extended families, and communities, our findings highlight the importance of financing and implementing universal access to emergency obstetric and neonatal care, and contraception, as well as social protection programs, including among remote populations.

Tracing shadows: How gendered power relations shape the impacts of maternal death on living children in sub Saharan Africa

“…Our findings are consistent with the existing literature on the linkages between gender inequalities, poverty, and MM, and the emerging evidence base regarding the enormous consequences of a maternal death, particularly in terms of creating vulnerabilities for the health and development of children (Bazile et al, 2015;Finlay et al, under review;Houle et al, 2015;Kenya MOH et al, 2014;Knight and Yamin, 2015;Moucheraud et al, 2015;.…”

“…For example, in South Africa, children whose mothers died from maternal causes had 15 times the risk of dying (p < 0.001) compared to children whose mothers survived; and in Ethiopia, 30% of children whose mothers died from maternal causes died as well, compared to only 4.4% of children whose mothers died non-maternal deaths (p < 0.001) (Houle et al, 2015;Moucheraud et al, 2015). Recognizing that the four countries are very diverse, we produced country-specific qualitative papers to better understand some of the contextspecific drivers of outcomes for maternal orphans (Bazile et al, 2015;Knight and Yamin, 2015;Molla et al, 2015;. Specific analyses of findings from each country, both qualitative and quantitative, and a detailed account of the research protocol for each country, are published or under review elsewhere (Bazile et al, 2015;Finlay et al, under review;Houle et al, 2015;Knight and Yamin, 2015;Molla et al, 2015;Moucheraud et al, 2015;.…”

“…Recognizing that the four countries are very diverse, we produced country-specific qualitative papers to better understand some of the contextspecific drivers of outcomes for maternal orphans (Bazile et al, 2015;Knight and Yamin, 2015;Molla et al, 2015;. Specific analyses of findings from each country, both qualitative and quantitative, and a detailed account of the research protocol for each country, are published or under review elsewhere (Bazile et al, 2015;Finlay et al, under review;Houle et al, 2015;Knight and Yamin, 2015;Molla et al, 2015;Moucheraud et al, 2015;.…”

Incidence of induced abortion in Malawi, 2015

“…Allowing for additional indications for safe and legal induced abortion could reduce the number of women who experience complications from unsafe abortion. In turn, this could save women’s lives, protect their well-being, conserve scarce financial resources [37], and prevent intergenerational impacts of maternal mortality on children, extended families, and communities throughout Malawi [38]. …”

Commentary: The proposed legislation on termination of pregnancy does not protect women or children in Malawi and is not fit for the intended purpose: Christian Medical and Dental Fellowshipi position

“…2 The World Health Organization (WHO) estimates that roughly 13% of maternal deaths may be accounted for by unsafe abortions, but the validity of studies contributing to this estimate have been questioned. 3 Liberalisation of the abortion laws is not the most effective way to reduce maternal mortality.…”