Travails of the Safe Motherhood Initiative in Malawi
The Loma Linda University Health and Faith Forum for October 10 focused upon the recent travails of the Safe Motherhood Initiative in Malawi, a tubular shaped nation in southeastern Africa. Ronald Mataya of the university's School of Public Health made the presentation and responded to questions from the audience of students, faculty and members of the community.
Mataya is an obstetrician and gynecologist from Malawi who divides his time between clinical medicine and public health endeavors. The session was moderated by Mark Carr, a professor in the School of Religion who also serves on campus as the Director of the Center for Christian Bioethics, one of the two organizations that sponsor these events. The other is the Center for Spiritual Life and Wholeness. Carla Gober, also a professor in the School of Religion, is its Director.
If I understood Mataya correctly, 75% of all health care in Malawi is provided by the government for which its citizens "prepay" in their taxes. There is no doubt that this system has dramatically reduced the rates of maternal and neonatal deaths; however, in recent years, despite the Safe Motherhood Initiative, which has been funded by various international organizations around the world, things have worsened. Earlier, I think it was in 1987, though I might be mistaken about this, there were 550 deaths per 100,000 live births. But by now this number has doubled to about 1,100 deaths per 100,000. Mataya holds that this change cannot be directly attributed to the prevalence of HIV/AIDS, though indirectly this fatal disease has made things worse by taking the lives of a signficant number of health care professionals.
What went wrong? Mataya attributes the greater success of the Safe Motherhood Initiatives in Sri Lanka and Malaysia to their greater collaboration with traditional healers and tribal leaders. Malawi's lessor emphasis upon this has contributed to the three "Deadly Delays." These are delays in (1) deciding to seek specialized medical care, (2) getting to the places where it is available, and (3) actually receiving it once there.
Many women bleed to death at the medical centers while they wait to see a physician, Mataya reported. This third delay is the most deadly. A shocking 52% of the deaths occur because of deficiencies in hospital care. The other half are distributed among a variety of other problems such as pregnancies that reoccur before the recommended three-year interval.
These problems are excaerbated by challenges that we see elsewhere in the world as well. One of these is the absence of health care delivery systems that provide accessible, affordable and acceptable medical care. Another is the unavailability of contraceptive measures and the cultural willingness to use them. A third is widespread and severe poverty. Still another is the prejudice against unmarried mothers that often causes them to receive inferior care. A fifth is the most widespread and deeply entrenched. This is the inequality between men and women. In Malawi this contributes to the three "Deadly Delays" because women often must wait for the men in their tribes to decide to send them away for the specialized medical care they already know they need.
Mataya responded to a number of questions. The first was whether "outsiders" should directly confront Malawi's patriarchal culture or foster change by working within it. Siding with neither, he held out for a "balance" of the two approaches. The last was whether it is appropriate for Westerners to impose their own changing values and norms upon other cultures. If he directly responded to this question, I did not hear his answer. His indirect response makes sense. It is that all people want to change when they see the destructive results of their customary behavior.
Like earlier Health and Faith Forums, it will soon be possible to view this session on the Internet. The easiest way to do this is to "Google" the "Research Channel." Once there, use the Search option to locate Loma Linda University. Having arrived at that location, use the same resource to locate the Forum of your choice by title, topic or the presenter's name.