Table 4.

Rules regarding ANC and institutional childbirth

Antenatal care visits “When a woman is three months pregnant she should start going for ANC; if she fails she should be fined” (by-law meeting).

Male involvement in ANC “When a man does not escort the wife to ANC there should be a punishment” (by-law meeting).  • This can be avoided if the woman has a letter from the chief justifying the absence of the husband.  • A trophy is given out quarterly to a health centre that has performed well in terms of male engagement (District health office/UNICEF)

Institutional childbirth “Women will be punished for not delivering in the health centre” (by-law meeting). Specific by-laws:  • “A woman who has gone to a TBA should be punished”.  • “When a woman delivers at home or on the way there should be a punishment”.  • “When a woman arrives late at the HC, she should be punished”. Penalties for home deliveries involve paying a goat or an amount between 3000 (USD 5) and 20,000 MKW (USD 35). Deliveries on the way to the facility are fined with 1500 MKW (USD 2.5) and for late arrivals 1000 MKW (USD 1,8)a.

^aAt the time of the research (2015) the exchange rate was approximately: 565 MWK = 1 USD. The GDP per capita was USD 1200. The household cost (medical and transport etc.) for women admitted to complication care in Malawi was approximately 7 USD in selected districts in 2015 [27]