Rosato, M; (2012) How does community mobilisation through MaiMwana women's groups work?: Addressing the social determinants of mother and child health in rural Malawi. Doctoral thesis , UCL (University College London).

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Abstract

Background: Over 340,000 maternal and 11 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 socio-environmental 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 and based on a conceptual model developed from the community empowerment literature, 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: On the basis of these results, I hypothesise that the MaiMwana women’s group intervention reduced maternal and child mortality by empowering community members in women’s groups 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.

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