Despite global commitment to the eradication of HIV/AIDS, the incidence of mother-tochild
transmission of HIV in sub-Saharan Africa remains extremely high: about 390,000
children are newly infected every year. The low uptake of Prevention of Mother-to-Child
Transmission (PMTCT) services in developing countries can be attributed to several
sociocultural and economic factors, such as; lack of male involvement in maternal and
reproductive health; gender disparities; and poor management of health care supply.
Cultural beliefs and values regarding women’s behaviour also account for the low
uptake of PMTCT programs.
This study contributes to the academic debate surrounding HIV-prevention and
empowerment. Women’s lived experiences are frequently missing from gender and
development policy, or pictured as oppressed. Gender roles and portrayals remain
static, which is not always in accordance with women’s own experiences and realities.
This thesis seeks to uncover how women are agents in making health decisions, while
also trying to be good wives, mothers and daughters.
Case study research has been done in rural Malawi, to illuminate the context in
which health decisions need to be made. The purpose of this study is to identify barriers
to the uptake of Prevention of Mother-to-Child Transmission services in Malawi through
women’s lived experiences and an assessment of the health system. The functioning of
rural health care delivery to women is analysed, as well as women’s agency in making
health decisions within sometimes limiting conditions.
The results of the study reveal that gendered norms and cultural practices
signficantly influence women’s actual and perceived access to health care services. Male
partners frequently do not lend their emotional and financial support. The lack of room
for disclosure of HIV status within the marriage contributes greatly to this. Ultimately
the research argues that PMTCT services should be placed a broader health perspective,
and help women develop tools to make decisions regarding their own reproductive
health