In the rural district of Chikwawa, 400 kilometres from Blantyre, Malawi, pregnant women are getting ready to go to the local hospital for antenatal care. Upon arrival, their experience begins with prayers and hymns before they receive a lecture about the importance of regular check-ups during pregnancy.
This is followed by an educational session facilitated by a group of women locally known as "Amayi Achinsinsi," which translates to 'Secret Mothers' who empower the mothers-to-be with knowledge and skills to ensure safe deliveries.
The Secret Mothers club is part of a broader effort to reduce Malawi's high maternal and neonatal mortality rates, is estimated at 381 per 100,000 live births. The group, which was set up by the Malawian government, aims to reduce maternal mortality rates to 1 per 1,000 live births and neonatal mortality to 12 per 1,000 live births by 2030.
Maria Chatola, a resident of Kavalo village -under the Kasisi Traditional Authority in Chikwawa -- recognised the prevalence of pregnant women who do not attend their antenatal and neonatal appointments. Compelled by this observation, she became an active member of the Secret Mothers Club, where she dedicated herself to educating and encouraging expectant mothers within her community to prioritise regular check-ups during their pregnancies.
According to Chatola, in the past, many women used to give birth at home because of the hilly and flood prone terrain of Kavalo Village. Almost every year, the area is affected by floods, and this forced expectant mothers to deliver in their homes due to inaccessibility. "I joined this club because I witnessed how women were delivering at home without any medical attention. They cannot cross the Shire River to reach better-equipped hospitals during labour."
Inside the Secret Mothers' Club
Since its establishment in 2012, the Secret Mothers Club has maintained a membership of around 100 women, each carefully selected by the local traditional authorities for their unique skill in providing care and support to expectant mothers. Their primary objective is to build trust between pregnant women and community health workers in rural areas, ultimately encouraging these women to give birth in hospitals and reducing the risk of complications during childbirth.
The club members serve as confidants for expectant mothers, providing support and advice while ensuring that all discussions remain private. They only disclose information to husbands when necessary, such as when the wife is experiencing pregnancy complications. This 'safe space' strategy lends credibility to their efforts, earning the trust of the community and nurturing an environment where maternal health services can thrive.
Stella Sabstone, a 50-year-old mother of three, has been serving Chiyang'anira village in Chikwawa as a Secret Mother for the past decade. She shares her firsthand experience of the important work being done at the grassroots level to improve maternal health in rural areas. "When we notice that the woman is pregnant, we organise ourselves and visit her to tell her what it means to have a baby coming."
Members conduct counselling sessions for pregnant women, helping them to understand the importance of going to the hospital for antenatal visits to avoid delivering their babies at home. They also educate expectant mothers on the importance of saving and procuring essential items like buckets, plastic papers, wrappers, and razor blades. They encourage gathering these items from the fourth or fifth month of pregnancy.
A bridge between mothers and health workers.
The cultural beliefs and remoteness of Chikwawa have created significant challenges for providing maternal healthcare services to the community. Many pregnant women miss important ante-natal visits, often having to travel 200 kilometres on deplorable roads to reach the nearest referral hospital.
According to Felix Santu, a Community Nursing and Midwifery Officer who also coordinates Community-Based Maternal and Neonatal Care (CBMNC) in Chikwawa, out of 250 catchment areas, 115 are in hard-to-reach areas.
The introduction of the programme was a deliberate strategy by Chikwawa's healthcare providers to bridge the communication gap between the community and healthcare workers. "Secret Mothers have been able to unearth some bad practices which have been happening with the [communities'] maternal health services," Santu said.
He explained that they encourage women to access health facilities immediately after noticing the pregnancy, "most of these Secret Mothers are [also] leading by example, when one of them is pregnant they start ante-natal visits right away."
Elizabeth Stephano, one of the beneficiaries of the initiative in Kavalo Village, explains how reluctant she was when she was approached by the club members. "I was furious when they visited me that I am pregnant. I remember I was 4 months. I asked them how they knew that I was pregnant," she said.
Stephano eventually relented after several months, heeding their advice to visit the hospital regularly for antenatal check-ups. Unaware of the serious complications associated with her pregnancy, such as swollen legs and abdominal pain. She was eventually referred to a hospital where a Caesarean Session (CS) was successfully performed.
Stephano later became a member of the club in 2014 and hopes that the club will continue to work on improving maternal health services in the country despite not having sponsors. She expressed gratitude for the Secret Mothers program, as many women have begun attending antenatal care, although more needs to be done to increase the number.
Enforcement measures taken
Sabstone described the implementation of local by-laws in her area, stating that any woman who gives birth at home is now subject to a fine of up to $50. Furthermore, if they encounter health issues post-partum and require a visit to the hospital, they are liable for an additional $50 fine.
Sabstone, who is among the pioneering members of the Secret Mothers' club in her community, underwent training from the local Health Surveillance Assistants (HSAs) and government medical personnel. She was equipped with maternal knowledge in order to create accurate awareness about maternal health in her community.
"We were chosen by the chiefs in our area," Sabstone noted, "because they see our dedication towards maternal health when [new] members want to join now, they tell us, and they have to undergo a certain training."
Sabstone, speaking about the efficiency of the programme, recounted the initial resistance they encountered from some mothers who were hesitant to accept their assistance. However, through their persistent efforts, they managed to gain the trust of the majority of expectant mothers, resulting in a significant improvement in the number of women visiting hospitals for maternal services in the hard-to-reach rural areas. According to Sabstone, out of every 10 expectant mothers, 8 are now accessing healthcare facilities.
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More training for members
Maria Chatola pleads for the support and training of more HSAs and Secret Mothers, who have been working in a voluntary capacity.
While they have been essential in providing vital healthcare services and support for mothers, she pointed out that their work is undermined by the absence of structure, training, and resources. This situation has worsened since the departure of a local non-governmental organisation known as the Centre for Alternatives for Victimised Women and Children (CAVWOC).
Chatola pointed out that the absence of CAVWOC has left a significant gap in the community's healthcare system, and volunteers have been left to fill this gap. However, without adequate training and support, their impact remains limited. She explained that some trained members have passed away or relocated, while several others lack updated training.
Chatola urged for fresh training to equip existing Secret Mothers with the necessary skills and knowledge to continue their crucial work, calling for new organisations to step in and offer comprehensive training programs. This would ensure that these volunteers can continue their vital work effectively and sustainably.
"There is a need to help us with frequent training so that the new members who have just joined will gain enough skills to operate as Secret Mothers in our communities. Saving lives of expectant mothers is not a single person's job, there is need to join hands," she said
