Social and Structural Factors Affecting Women’s Participation in Prevention of Mother to Child (PMTCT) Programs in MalawiIn 2012, 17.7 million women were living with HIV. Ninety percent of these women lived in Sub-Saharan Africa. Malawi is especially impacted, with some of the highest rates of HIV infection in pregnant women in the world. In 2010, 63,500 pregnant women in Malawi required antiretroviral (ARV) prophylaxis. Of these women, only 53% received ARVs through PMTCT programs. In 2011, in an effort to expand access to treatment services within PMTCT programs, the Malawian Ministry of Health implemented Plan B+, a policy designed to expand access to treatment services within PMTCT programs. Plan B+ now offers lifelong treatment to all pregnant women and new mothers who test positive for the HIV virus, regardless of CD4 count. Despite a substantial national scale-up of PMTCT services, retaining women within PMTCT programs remains a challenge to successful implementation of these interventions. Recent literature suggests that approximately 27-55% of women enrolled in PMTCT programs fail to remain in them. This dissertation examines the social, cultural, and economic forces affecting women’s participation in Prevention of Mother to Child Transmission (PMTCT) programs in Southern Malawi. I employ qualitative methods including semi-structured interviews, focus group discussions and clinical observations with PMTCT patients, health care providers and community members to better understand why some women do not remain in these programs. The research questions examine: 1) the experiences and health seeking strategies employed by pregnant and postpartum women, 2) how broader social and gender relations affect women’ participation in the program, and conversely, 3) how participation in the program affects women’s social and gender relations. I argue that gender and power inequities shape women’s social relations in marriage, the community, and the clinic, challenging women’s social identities, and constraining their health seeking practices, thus demonstrating how gender inequities become embodied in the health outcomes of HIV positive women.
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