Giving birth in rural Malawi : perceptions, power and decision-making in a matrilineal community
This anthropological study exammes the relationships, influences and power dynanucs underpinning decisions made around childbearing in a resource-poor subsistence farming community in southern Malawi. Local literature and relevant anthropological and technical sources are exan1ined for childbearing themes, patterns of residence and relatedness, knowledge and power, health perceptions and risk Methodological and ethical issues are analysed, taking a reflective approach toward the author's n1idwifery background. The study is founded in the view that understanding childbearing processes has inherent value for women's wellbeing, but also can contribute insights into wider social themes and contribute to anthropological debates. A strongly matrilineal and matrilocal lifestyle is revealed with substantial power residing with older women. Men are heads of households when resident and responsible for the welfare of their own matrikin. TIus dynamic is exan1ined indicating that cluldbearing women's older female matrikin make most decisions, at least for younger women, and men generally support them. To understand decision-making, perceptions of health and childbearing, and concepts of risk are examined. Biomedical ideas are layered with ethnomedical, and local expressions of morality. Ideas of childbearing risk are grounded in this eclectic view, with biological problems often linked with causation, and resolution congruent ·with local cosmology. These include hot/cold imbalance, maintenance of the life-force, adultery in pregnancy, bewitching and pollution and taboo. The development and legitimacy of knowledge used to make decisions is exan1ined. Older women retain control; most young women remaining too ignorant for independent action, but all ages demonstrate acceptance of the knowledge of the formal health service. The overall scenario is of generally benevolent control of younger women using a power base grounded in matrilineal relatedness and eclectic concepts, knowledge and notions of risk to make childbearing decisions. Choices are however ultimately pragmatic and dependent on circumstance with neither local concepts nor biomedical ideas prevailing.