Background: Over 340,000 maternal and 8 million child deaths occur globally every year.
These deaths are underpinned by physiological, behavioural and social determinants. Efforts to
achieve Millennium Development Goals 4 and 5 for mother and child health have
predominantly sought to address the physiological and behavioural risk factors. A few
community mobilisation interventions, particularly those seeking to empower communities,
have also sought to reduce mortality by addressing the social determinants of health but little is
known about how they work. This thesis attempts to address this by illuminating the socioenvironmental
mechanism through which the MaiMwana women’s group intervention in
Malawi reduced maternal and child mortality.
Methods: A grounded theory methodology, utilising observation and focus group discussion
methods was used to explore how the actions of the MaiMwana women’s group intervention
helped to organise and mobilise community members to take control of the social determinants
of mother and child health.
Results: The actions of the MaiMwana women’s group intervention built the capacities
(knowledge, skills, opportunities and attitudes) of community members to become increasingly
organised and mobilised (coming together, identifying common problems, receiving structure
and direction, becoming organised, mobilising resources, developing partnerships, becoming
critically conscious of the root causes of their problems, receiving power to take control of the
women’s group programme and actually taking this control) which in turn generated
interpersonal elements (resources and relationships) that they could draw on to address the
social determinants of mother and child health.
Discussion: The MaiMwana women’s group intervention reduced maternal and child mortality
by empowering women’s group members to harness the interpersonal elements that arose as
they became organised and mobilised and bring them to bear on the structural and
intermediary social determinants of health through individual, organisational and community
action thus reducing their exposure and vulnerability to health-compromising conditions.