A matter of life and birth: health seeking experiences of HIV positive women in Malawi

Abstract

Despite global commitment to the eradication of HIV/AIDS, the incidence of mother-to-child 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.