About stereotypes, traditional practices and culture: Experiences from field work in Malawi

Written by Hanneke Pot, PhD candidate at Centre for Development and the Environment, University of Oslo 

To Malawi for fieldwork

During my first weeks in Malawi, I met with a staff member of an International Non-Governmental Organization (INGO). Over a cup of tea, we discussed a possible location for my fieldwork. I was interested in studying the dynamic relationships between NGOs and local communities and how this shaped the implementation of a project aiming to reduce teenage pregnancies and keep girls in school.  The Malawian INGO staff member was fascinated by Mangochi, a district which he described as having ‘bad’ indicators in the fields of health and education compared to the national average, but which on the other hand was quite developed in terms of economic activity. He mentioned that cultural values and practices were the main reason for these bad indicators. In other districts, he argued, people were more accepting towards programs. However, the ‘bad’ status of Mangochi was relative, as nationwide as much as 29 per cent of girls between the ages of 15 and 19 have begun child bearing and the median years of completed education for women aged 15-49 is 5.6 (for men 6.6) [1]. In Malawi, young motherhood was the norm.

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Stereotypes at several levels

The more NGO staff and senior government officials I spoke to, the more I became aware of people’s strong stereotypical ideas about Mangochi: The dominant tribe in Mangochi – the Yao – did not value education because they were Muslims. They highly valued traditional practices such as initiation ceremonies and early marriages, aimed to protect their culture and therefore resisted development discourses. Having some prior knowledge of Islam, the logic of resisting western education out of religious conviction did not make sense to me. I knew Islam as a religion in which knowledge and education were highly valued. This puzzle fascinated me. How could elite Malawians’ perception of Islam be so different from mine? And why were traditional practices and culture so central in the explanation for the ‘bad’ indicators in Mangochi district?

A couple of weeks later I was on my way to Mangochi, a four-hour drive from the capital Lilongwe, crossing the mountains and fertile lands of Dedza district. The beautiful and peaceful scenery was somewhat in contrast with the immensely busy and vibrant atmosphere in Mangochi, located at the southern end of Lake Malawi. There were bicycles everywhere, transporting people, but also merchandise, between markets. On one side of the lake there were tourist lodges, the larger ones had conference halls, which were used for NGO-organized meetings. The population was ethnically mixed and residence to people from different parts of Malawi. The other side of the lake was calmer in terms of economic activity, and the population was more homogeneous Yao. I chose a village on the side with the mixed population as fieldwork location.

Conducting participant observation in the implementation of an INGO project with a behavior change approach and studying in-depth one rural area in which it was meant to make a difference, provided me with unique insights. I learned how the INGO staff ‘translated’ the content of the project to specificities of the district, how INGO staff and government stakeholders talked about the project and the target population during project meetings, but also how the project related to local realities in rural Malawi. One finding that stood out was the stereotypical portrayal of the Yao tribe, the overemphasis on a static uniform culture to explain bad indicators, and how this was in discordance with local realities shaped by poverty, daily uncertainties and lack of options to formal employment.

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Emphasis on cultural and behavioral factors amongst INGO staff

Whereas the INGO staff attributed the Yao’s low educational attendance to a distant past in which they had resisted missionary education out of refusal to convert to Christianity, INGO staff completely passed over the influence of more recent events. The 1994 Free Primary Education policy had doubled the enrollment but deteriorated the quality of education. In the southern region of Malawi, this reinforced the idea that education was insignificant to secure livelihoods that were severely affected by the AIDS crisis [2]. There seemed to be no collective cultural or religious resistance towards education. Rather, to many villagers the importance of education was related to various notions of development. For some this meant a strong focus on tangibles, such as iron sheet houses, sleeping on a mattress, or having braided hair. To others, development meant envisioning getting an education and formal employment. Yet, achieving these dreams proved to be challenging.

When implementing interventions with a behavior change approach, discussions during INGO-community meetings were almost inevitably steered towards those factors that could be changed by the project: behavioral determinants. Although in private conversations INGO staff acknowledged the structural inequalities that characterized village life, they could not address these issues with the project. It was their job to convince local communities that education would lead to a better future, thereby constructing education and teenage pregnancies as oppositional. What therefore became the topic of discussion during INGO-community meetings were the behavioral and cultural factors that could be changed to achieve these aims. As such, poverty became a superficial factor, and culture the deeper layered problem, instead of the other way around.

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Focus on culture reflects dichotomies

Through such meetings, INGO staff talked about tradition and culture as something static, as an entity in itself, uninfluenced over time. The fuss about ‘harmful cultural practices’ in Malawi seemed to reflect dichotomies between elites and villagers, modernity and tradition, urban and rural, educated and ignorant. As such, a project about reducing teenage pregnancies and keeping girls in school that appeared to be morally neutral due to its scientific underpinnings, played out as a moral discourse for rural girls and communities to abandon their traditional practices and become modern educated Malawians, blaming culture in its course.

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Hanneke Pot with research assistants Gertrude Finyiza and Beatrice Chibayo

  1. NSO and ICF, Malawi Demographic and Health Survey 2015-16. 2017, National Statistical Office [NSO] Malawi and ICF: Zomba, Malawi and Rockville, Maryland, USA.
  2. Kendall, N., Education for All Meets Political Democratization: Free Primary Education and the Neoliberalization of the Malawian School and State. Comparative Education Review, 2007. 51(3): p. 281-305.

Improving the quality of reproductive healthcare in Georgia – About the creation of a Georgian birth registry

Written by Ingvild Hersoug Nedberg (MPH), Natia Skhvitaridze (MD, MBA) and Tinatin Manjavidze (DD, MPH) from UiT The Arctic University of Norway  

Maternal and perinatal mortality and morbidity are frequently referred to as the most important indicators related to the health of a nation and is used as a measure of quality of the reproductive health care system. One of the major challenges to improve a health care system is unreliable patient-data and methods of collecting data. A country can improve the quality and efficiency of their reproductive health care system with the use of a medical birth registry with high quality and accurate data, as has been done in Georgia.   


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Health data in Georgia

Georgia is a developing country with several problems related to their healthcare system. Among the challenges are how to improve the quality of care and its effectiveness. Reduction of maternal and children morbidity and mortality has been an important goal for the United Nations Millennium Development Goals (MDG) and is now the priority for the Sustainable Development Goals (SDG). Maternal and newborns deaths are crucial to report accurately. However, Georgia has been lacking precise and longitudinal data dealing with maternal and newborns mortality and morbidity. Until 2016, data on reproductive health services came from sporadic on-demand surveys. Routine info on mortality and morbidity was available as aggregated data with a lack of epidemiological analysis.


Using data for research and education

The Georgian Birth Registry (GBR) was implemented 1January 2016 with the aim of collecting reliable information and ensuring accurate reporting of data with high quality and completeness. It is the first developing country to implement a national, digital medical birth registry, and it was made possible by the initiative and great enthusiasm from the involved actors.

The introduction of the GBR in Georgia has made it possible to create a database, which can be used for epidemiological analysis and recommend evidence-based findings. We are three PhD-students (two Georgians living in Georgia and one Norwegian) accepted at UiT The Arctic University of Norway in the Department of Community Medicine to work and develop our studies. We are all using data from the GBR and our projects deal with maternal and perinatal mortality and morbidity, and cesareans sections.

The supervising team consists of main supervisors in Norway and co-supervisors in Georgia from different scientific backgrounds and clinical experience.


How it works

We started our PhD in January 2017 and we all study full-time. We attend relevant PhD-courses together in Norway and gather for common supervision either in Norway or in Georgia at least four times a year. We also have weekly communication by Skype. We arranged a writing gathering in February 2018 where supervisors and PhD-students came together for a week in the mountains of Georgia to write the outline of our first paper, a highly effective way of working and something we would recommend for other PhD-students working on common data material. The Norwegian and Georgian partners in the project also organize annual conferences to review progress and challenges with the birth registry and other parts of the project.

Due to the recent implementation of the GBR, we have spent much time reviewing the quality of the variables in the registry, trying to find out why some are poorly filled out while others seem to be misunderstood. It is also important to make a detailed and up-to-date codebook of all the 470 variables with detailed explanations of coding and meaning, to avoid misunderstandings and provide a working tool for all those involved in using the GBR data. This work is not directly related to our projects, but is valuable to understand how a national registry is set up, what it takes to make it work and not the least how much time it takes to clean a dataset before it is ready for analyses!



We believe that our studies, through our PhD-projects, can contribute to the improvement of the Georgian reproductive health system by providing descriptions and analyses of data never published before and suggestions for improving maternal and newborn health.


For more information contact:

Ingvild Hersoug Nedberg – ingvild.h.nedberg@uit.no

Natia Skhvitaridze – natia.skhvitaridze@uit.no

Tinatin Manjavidze – tinatin.manjavidze@uit.no


The Norwegian Center for International Cooperation in Education (SIU) funded the project ”Georgian-Norwegian Collaborative in Public Health (GeNoC-PH)” in 2016 with the following participants:

  • UiT The Arctic University of Norway (UiT)
  • University of Georgia (UG)
  • Ivane Javakhishvili Tbilisi State University (TSU)
  • National Center for Disease Control and Public Health of Georgia (NCDC)
  • United Nations Children’s Fund (UNICEF)
  • Consulting & IT Innovations (CiTi)