Chapter 2

Methodology

This qualitative research study was conducted among a population of Malawian women living in the sub-urban areas of the cities of Lilongwe and Blantyre and in the district of Ntcheu. (See Appendix IV Map of Malawi) The informants were selected from these areas because the areas were easily accessible and convenient in terms of transportation.

The women interviewed in Blantyre were from the ethnic group of the Yaos, those interviewed in Lilongwe were Tumbukas and those interviewed in Ntcheu were Ngoni. Originally, Tumbuka people come from the Northern region of the country but the Tumbuka women that were interviewed lived in the city of Lilongwe because of their husbands' or parents' search for employment. Likewise, many of the Yao women that were interviewed in Blantyre were originally from the district of Mangochi but had moved to Blantyre in search of employment. The women that were interviewed in Ntcheu district were Ngoni and were all originally from the same district. The interviews were conducted mostly in Chichewa which is the national language of Malawi. However, in a few cases, particularly for those with a higher level of education, the women interjected English words or phrases during the interview.

The interviewees were purposively selected from three ethnic groups, namely, Yao, Tumbuka and Ngoni. I did this so as to acquire an accurate representation in terms of the culture of childbearing for women throughout the country. The three ethnic groups selected represent the Northern, Central and Southern regions of the country: the Tumbuka in the North, the Ngoni in the Central and the Yao in the South. Furthermore, this sample of women originating from all regions of the country enriched the data as the details given by the women, although similar in many instances, were also quite diverse. Consequently, this approach enabled me to compare and contrast as well as determine which practices of one group would be beneficial to another, if adopted. Although only five of the interviewees reside in their actual district of origin, I believe that they are a true representation of the respective ethnic groups to which they belong evidenced by the way they continue to observe the cultural practices pertinent to their specific ethnicity.

Between December 14^th 1997 and January 12^th 1998, 18 women were identified as informants; three were traditional birth attendants, one of them formally trained by health authorities in the city of Blantyre and the other two trained by elderly women in their communities. Traditional birth attendants are essential community health workers in Malawi as in many other developing countries.

Most women interviewed for this study sought the services of traditional birth attendants during labor and delivery as opposed to formally trained midwives in the hospitals because of lack of transportation to the faraway hospitals and fear of the midwives who are often impatient and unsympathetic. Nevertheless, the women did appreciate the significance of hospital deliveries. Good (1987) states, "If available and accessible, Africans commonly select biomedicine first for acute and life-threatening diseases" (p. 311).

All of the 18 informants that were interviewed made mention that they would generally prefer to deliver their babies in a hospital setting in case of an emergency such as bleeding to ensure that they received prompt treatment and thus avoided complications. One of the traditional birth attendants despite encouraging women in her community to be delivered by herself mentioned that she always made sure that necessary transport arrangements were made for her own pregnant daughters so that they were taken to the hospital for their deliveries. This clearly shows the women’s realization of the importance of hospital deliveries even though many of them are still delivered by the traditional birth attendants at home.

Given the adequate resources, material as well as human, maternal and infant morbidity and mortality would decrease considerably if most of the women were delivered in a hospital setting. This is because interventions for acute high risk conditions such as cord prolapse would be carried out swiftly before further complications arose. At present however, traditional birth attendants are a vital resource in meeting the objectives of the primary health care program which emphasizes the strengthening of preventing and promotive maternal and child health services. Traditional birth attendants are essential considering the large population of Malawians in the rural areas and the lack of health personnel, most of whom are situated in the urban health institutions.