The majority of Malawian women do not return to the hospital for postnatal care after delivery, a development that has contributed towards high maternal death rates both locally and globally, research findings by two leading Malawian health experts indicate.
These findings are contained in the ‘Evidence Based Midwifery (EBM)’ Magazine edition of December. This is a quarterly journal published by the Royal College of Midwives And features academic research findings from around the world.
Presenting the findings after analyzing factors that influence utilization of postnatal care (PNC) between the first and sixth week of delivery among mothers at Zomba Central Hospital, Head of the Midwifery Department at Malawi College of Health Sciences, Betty Sakala, and Abigail Kazembe- a lecturer in Maternal and Child Health at Kamuzu College of Nursing- say most urban women shun PNC.
“Two-thirds of all women that deliver in urban hospitals in Malawi do not return for PNC care at one and six weeks,” reads part of their report.
Sakala and Kazembe warn that this situation could impact negatively on Malawi’s maternal statistics because, after delivery, both the genital and the urinary tract are prone to infections arising from the labour process.
“Follow up of the mother within the first week is critical for detecting postpartum infections. Although postnatal services are free, 69 percent do not return for one week and six weeks PNC,” observes Sakala and Kazembe in the report.
The 2011 Malawi Demographic and Health Survey indicates that the country’s maternal mortality rate is at 6.7 per 1000 live births. However, a 2008 United Nations Children’s Fund and National Statistical Office report partly attributed Malawi’s high mortality rate to women’s failure to attend PNC.
However, the study- which was approved by the College of Medicine’s Ethical Review Board and had a sample of 154 women- has placed the blame on midwives’ failure to advise women on the importance of attending to PNC, lack of awareness on postnatal services, low levels of education among most women and poor enforcement of growth-monitoring mechanisms.
The report suggests that, as part of the solutions, medical training institutions should emphasise the importance of PNC at between one and six weeks of delivery. It also suggests that midwives’ supervisors should ensure that mothers are advised and booked for postnatal care.
This is not the first time that research findings have revealed that most Malawian women shun PNC services. For instance, the Malawi Multiple Indicator Cluster Survey report of 2006 reported that the mothers’ age and education levels had a positive influence on PNC services, citing the “increased reasoning capacity of older women”, as opposed to younger girls, as one of the factors that promotes access to PNC services.
The report also noted that women with secondary education or higher were more likely to go for PNC within 42 hours after delivery (54.0%), compared to women with no education (29.0%). It also said working women are more empowered to make decisions on when to go for PNC due to their financial independence.