From the New York Times Fixes blog:
Malawi is a country of rolling hills and marshy flatlands, where 85 percent of the population live in the countryside, most subsisting on less than $2 per person per day, typically from corn and tobacco farming. It is also a country with extremely high maternal mortality. In the U.S., 1 in 2,400 women are at risk of dying while giving birth over the course of their lives; in Malawi, it is 1 out of 36. If the country’s new president, Joyce Banda, has her way, that will soon change.
Banda has created a bold plan to improve maternal care nationwide. The vast majority of births in Malawi still happen under the care of traditional birth attendants, who are often unequipped to deal with potentially lethal complications.
But a national ban on giving birth at home with attendants, established in 2007, didn’t make the dent that Banda’s predecessors hoped it would. Most Malawians ignored it in favor of the customs that have governed their lives for as long as anyone can remember. The problem is not something that can be solved solely through legislation; a massive cultural shift is needed. The question is: how can a government lead such a change?
If Banda is to succeed (and she is up for reelection in 2014), it will depend, in part, on her government’s ability to harness the country’s true power brokers, Malawi’s 20,000 village chiefs — and sensitize them to the dangers of women giving birth with attendants, while still respecting tribal traditions.
Read the complete post here.