Enforcing 'Progress': A Story of an MDG 5 Indicator and Maternal Health in Malawi

摘要

Considering the importance of metrics in current systems of global health accountability, this article analyses the dynamics behind a maternal health indicator. To achieve the target of Millennium Development Goal 5 (MDG5) and increase the proportion of births attended by 'skilled health personnel', some districts in Malawi in 2010 introduced information campaigns to promote births in hospitals and a fine to punish mothers who delivered outside of biomedical health institutions. The study is based on ethnographic research in one Malawian village. While many mothers described the ill treatment and bad conditions in maternity wards, most women still started to publicly sanction institutional births. This apparent contradiction can be understood by looking at the positions and motivations of the various actors who participated in the performance of MDG 5 in the village and how their projects became tied to the focus on improving the indicator. Rather than expressing a demand for the existing maternal health services as such, the ethnography suggests that the actors' practices expressed hopes and claims to wider material improvements in a context of inequality. The article highlights dynamics that are concealed if we restrict the analysis to one of biopower, and expands the purview of the study of metrics into the spaces which indicators are intended to represent.