Malawi is back in the news again, this time over President Joyce Banda’s plan to improve maternal mortality by harnessing the power of village-level “safe motherhood committees” comprised of community members with distinct roles (i.e. family planning counselors, growth monitors) to support health among the villages’ mothers and young children. One of the key roles in this committee is that of “secret mother,” a role usually filled by an elder woman who serves as a liaison between expectant mothers and healthcare practitioners from conception until post-delivery. By monitoring the expectant mother’s health and ensuring she accesses ante-natal care, delivers in a health facility, and receives post-natal care, Banda and others hope these “secret mothers” will reduce the influence of traditional birth attendants (TBAs), who often lack the skills to deal with pregnancy complications.

It’s a good idea, one that preserves the intergenerational bond provided by TBAs while bridging the gap between tradition and modernity. And it’s certainly an improvement over the 2007 national ban on home-births with attendants, which has failed to deliver on its promise to significantly reduce maternal mortality. I can’t help but wonder, though, if Malawi is missing a golden opportunity to bring these TBAs into the larger fold of the nation’s health surveillance assistant (HSA) program.

Over the past six months, I’ve worked directly with HSAs and have had many discussions with my colleagues about the weaknesses of the HSA program. One of the main challenges has been a lack of commitment on the part of the HSAs, many of whom are not from the communities they serve and who are awarded these positions based on their connections to high-powered government officials. The TBAs represent a unique opportunity then to recruit women who have a vested interest in the well-being of their community. Why ban TBAs outright, stripping them of their social and culture influence? Why not invest in them, train them to provide ante-natal counseling, and use them to strengthen an already struggling HSA program?


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