Paper short abstract:

This paper explores the distinct conceptualisations of risk, complications, and’ safe’ deliveries by different actors in maternal health in Malawi, which shape the choice of ‘best’ delivery place. We discuss how tensions may arise between the expectations of, and satisfaction with, the care women receive in hard to reach rural areas.

Paper long abstract:

Globally, childbirth continues to be framed within a discourse of risks which can be best managed in facilities, by skilled attendants and through interventions, in order to reduce maternal mortality. Women's perception of risk -and choice of delivery place-is often influenced by their care providers, former experiences and by public information. In Malawi, where the maternal mortality ratio is high (510/100,000), the risk discourse equally pervades and the Government has prioritised skilled birth attendance and institutional deliveries. In 2007, it issued Community Guidelines preventing deliveries by Traditional Birth Attendants (TBA)- the non-formally trained, community providers of maternal care-, whom are publicly portrayed as insufficiently skilled, unsafe and often blamed for complications arising.

This presentation draws on findings from a larger qualitative study of the perceived effects of this new policy implementation, which uses a grounded theory methodology to analyse 65 interviews and focus groups conducted with a range of stakeholders in 2013 in Malawi. These findings explore:

• how risks and complications are conceptualised distinctively by skilled birth attendants, TBAs and the women they serve

• How those concepts are in turn mobilised to serve either the Safe Motherhood Initiative's goals; or for women to navigate the risky waters of 'safe' deliveries.

Drawing upon frameworks of authoritative knowledge and theories of quality of care (QoC), we develop a theory of what women perceive as 'good/best' delivery care, and how expectations and satisfaction of out-of-reach rural women, could be better met by interventions to improve the quality of delivery care in Malawi.