Ethical concerns in maternal and child healthcare in Malawi

Abstract

Background Caring is a core function of nurses and it confers upon them ethical obligations as ethical agents. Failure to carry out such ethical obligations raises ethical concerns. This study was not intended to explore ethical concerns, but the reported findings reveal problems which have ethical implications. This paper aims to elucidate the ethical issues inherent in the findings and propose strategies to mitigate them. Research design and methods An exploratory-descriptive qualitative design was used within a larger Action Research Study. Data were collected through focus group discussions with nurse/midwives, and through exit interviews which were conducted with the women who participated in the study on their day of discharge. Six focus group discussions and thirty exit interviews were conducted, and data were analysed through thematic analysis. Participants and research context The study took place at selected maternal and child healthcare settings in Lilongwe, Malawi. The participants were nurse/midwives and women who were admitted in maternal and child healthcare settings and were purposively sampled. Ethical considerations Ethical approval was obtained from the relevant ethics committee and all ethical guidelines were followed in the conduct of the study. Findings The findings are presented under three themes which emerged from the data. The findings reveal effects of staff shortages on patient outcomes, problems experienced in low resource clinical settings and disrespectful nurse/patient communication. Conclusion The findings reveal that institutional factors constrain moral agency and patient safety is severely compromised in some of the clinical settings in Malawi which raises serious ethical concerns.

‘No other alternative than to compromise’: Experiences of midwives/nurses providing care in the context of scarce resources

“…Nurses and midwives are required to provide safe, quality, and ethical care to patients but their ability to meet these expectations is profoundly influenced by the conditions under which they practice. In sub‐Saharan Africa where healthcare systems are fraught with chronic resource shortages, meeting the basic care needs of patients and maintaining safe and ethical practice remains a mirage for nurses and midwives (Boakye et al, 2021; Floyd, 2013; Msiska et al, 2021). The inherent ethical nature of midwifery practice whereby midwives work between their own values, the sociocultural values of childbearing women and the values of the institutions add to the complexity of their situation.…”