The changing dynamics of community care and support in rural Malawi: The impact on Women's health and wellbeing at end of life

Maren M Hawkins; Anne Dressel; Nancy Kendall; Claire Wendland; Stephen Hawkins; Kimberly Walker; Elizabeth Mkandawire; Jackline Kirungi; Peninnah Kako; Lucy Mkandawire-Valhmu

doi:10.1016/j.socscimed.2022.114934

The changing dynamics of community care and support in rural Malawi: The impact on Women's health and wellbeing at end of life

Soc Sci Med. 2022 May:301:114934. doi: 10.1016/j.socscimed.2022.114934. Epub 2022 Mar 18.

Affiliations

¹ University of Wisconsin-Milwaukee Joseph J. Zilber School of Public Health, 1240 N 10th St, Milwaukee, WI 53205, USA. Electronic address: hawkinsm@uwm.edu.
² University of Wisconsin-Milwaukee, College of Nursing, 1921 E. Hartford Avenue Milwaukee, WI 53211, USA.
³ University of Wisconsin-Madison School of Education, 1000 Bascom Mall, Madison, WI 53706, USA.
⁴ University of Wisconsin-Madison Departments of Anthropology and Obstetrics & Gynecology, 1180 Observatory Dr, WI 53706 & 20 S Park St, Madison, WI 53715, USA.
⁵ University of Wisconsin-Milwaukee College of Letters & Science Department of Sociology, 2442 E Hartford Ave, Milwaukee, WI 53201, USA.
⁶ University of Pretoria, Lynnwood Rd, Hatfield, Pretoria, 0002, South Africa.
⁷ University of Wisconsin-Milwaukee College of Letters & Science Department of African and African Diaspora Studies, 2442 E Hartford Ave, Milwaukee, WI 53201, USA.

PMID: 35378429
DOI: 10.1016/j.socscimed.2022.114934

Abstract

In this critical ethnographic study, we examined women's end of life experiences in Malawi, one of the few countries in the world with a national palliative care policy. Specifically, we explored how women's and their caregivers' experiences were shaped by family and community care, and material needs. Interviews and observations with female clients of a non-governmental organization in rural Central Malawi, and with their caregivers, revealed that community-level support was both precarious and critical. We found three main themes: (1) I stay with them well, (2) we eat together, and (3) everyone is for themselves. The analysis illustrates the centrality of community care, social in/exclusion, and availability of stable food, shelter, medical, and caregiving resources on health and wellbeing at end of life. We provide recommendations to strengthen community care opportunities and women's resource bases.

Keywords: Community care; Critical ethnography; End of life care; Malawi; Palliative care; Qualitative research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Death
Female
Humans
Malawi
Palliative Care
Rural Population*
Women's Health*