Maternal deaths remain a public health challenge in most developing countries including Malawi.
Although Maternal Mortality Ratio (MMR) is reported to have declined from 1120/100,000 in 2000 to
675/100,000 in 2010, Malawi‘s MMR is still ranked among the highest in the world. Despite government
efforts to address this challenge through health facilities, women access and use of such service is not yet
universal.
Utilising data from 2000, 2004 and 2010 Malawi Demographic and Health Surveys, the study
investigated factors influencing women‘s use of maternal health services using logistic regressions and
decomposition techniques. The study population comprised 7919, 7309 and 13776 women who gave birth
in the last five years preceding each survey. Furthermore, the study interviewed 12 health workers and 60
women selected from health centres across the country to explore their perspectives on the state of
maternal health services.
The study established that women‘s use of antenatal care for more than 4 times during pregnancy
remained unchanged at about 57.1% in 2000 and 2004 and declined to 45.0% in 2010. The study also
revealed that women‘s age, birth order, education, exposure to media and quality of care predicted
women‘s use of health care services during pregnancy period. Women‘s use of public health care
facilities during childbirth stood at 42.3% in 2000 and 2004 and increased to 61.4% in 2010. It was found
that timing of antenatal care, women‘s age, birth order, education, media exposure, religion, women‘s
earning status and quality of care were the major predictors of women choice of public health care
services during childbirth.
The study also found that the use of postnatal care services was very low at 2% in 2000 increasing to 20%
in 2004 and 30% in 2010. This was largely attributed to by antenatal care, maternal education, place of
residence and quality of care. Overall, based on these findings, it was established that women‘s individual
and community factors were the major contributors associated with utilization of maternal health services.
Discussions with the health workers and women revealed in general that maternal health care services in
Malawi are constrained by resources such as financing, adequate medical equipment and supplies,
inadequate incentives to motivate health workers, failures which inadvertentanly lead to bad attitude
during service delivery.
Based on these findings, the study recommends that policies that will ensure improvements in maternal
health services in Malawi should be promoted and strengthened. Some of these strategies must include
programmes that enhance the social and economic status of the population. Above all, initiatives that
encourage women to use maternal health services, particularly in the socially and economically
disadvantaged communities should be promoted. There is also a need to undertake further research
regarding health financing and gaps affecting effective delivery of health care services in Malawi.