On 10 December, 77 years after the Universal Declaration of Human Rights,Malawi’s second vice president Enock Kamzingeni Chihana made a familiar declaration about human rights being one of the country’s “everyday essentials”. But in districts like Mulanje, Mangochi and Machinga, where women walk for hours to reach a health post, girls marry before they understand what marriage means and corruption siphons away public funds meant to keep people alive, the words ring hollow. In most rural health facilities in Malawi, the first thing that is noticeable is what’s missing.
Sometimes not even running water. Some 87% of births happen in rural communities, yet the health system is built everywhere except where women live. As a result, the country’s maternal mortality rate is 381 deaths per 100 000 live births, one of the highest in the world.
In Mulanje, one of the poorest districts, pregnant women wake before dawn to begin the walk, two or sometimes three hours on rutted dirt roads, to antenatal clinics. When labour complications occur, the delay in reaching a hospital can be fatal. Malawi closed 20 health posts almost overnight.
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Communities talk about women giving birth in fields, on footpaths, and on motorbikes because there is nowhere else to go. “Women are giving birth on their way to the district hospital. The distance is killing them,” community leader Massitive Matekenya said.
In 2024, only 20 new health centres were under construction for a population of 20 million. Corruption further weakens the system, with health-sector procurement audits showing medicines bought at inflated prices, tenders given to political allies and stock disappearing before it reaches clinics.
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