Encouraging Healthy Practices Among Pregnant Women through Active Listening

Encouraging Healthy Practices Among Pregnant Women through Active Listening

{Photo credit: Amelie Sow-Dia}Charlene Chisema, a community mobilization officer, conducts an Education Through Listening session on antenatal care.Photo credit: Amelie Sow-Dia

It is early afternoon in the village of Kanjuwale at the foot of Nguluyanawambe Mountain in central Malawi. Charlene Chisema, a community mobilization officer, asks a group of local women about best antenatal care (ANC) practices.

“It should start early – in the first months,” said one woman.

“You need four visits,” said another.

“Great!” said Chisema, who works with the Organized Network of Services for Everyone’s (ONSE) Health Activity. “How many ANC visits did you all have during your last pregnancy?”


Suddenly, a frail woman with a baby on her lap stood up, wiped a tear from her face, and said, “I will not return to ANC.”  

The women looked shocked – they were not used to such candid talk.

“Thank you for being honest,” said Chisema, leaning forward with an encouraging smile.  “Please tell us why.”

Grace sat back down, wiped her face with her cloth wrap, and explained how the nurse at the local health post has been teasing her for “being pregnant again, while my baby, barely six months old, is still exclusively breastfeeding!”

This is the point of Education-Through-Listening (ETL) – to create a non-threatening atmosphere to enable clients to speak openly about obstacles that prevent them from practicing healthy behaviors such as attending ANC. ONSE Health, which is funded by the US Agency for International Development (USAID), launched at the end of 2016, will also be working at health facilities in Malawi to improve the interactions between health providers and women for pregnancy and delivery care. The five-year activity is working to increase access to and demand for quality maternal and child health services in 16 target districts. It is implemented by Management Sciences for Health; Banja la Mtsogolo; Village Reach; Overseas Strategic Consulting, Ltd.; Development Innovation Group; and Dimagi.

ANC provided by a skilled provider allows close pregnancy monitoring, reducing morbidity and mortality risks for mother and child. Although 95 percent of women who gave birth in the past five years in Malawi received ANC at least once during their last pregnancy, only 51 percent attended the recommended minimum of four visits. Increasing demand for high-impact services such as ANC is one of ONSE Health’s goals.

Chisema is one of 23 Malawian health professionals whom ONSE Health trained as an ETL master trainer in April 2017 to strengthen interpersonal communication skills of district health teams who will then train community-level workers within the next three months. Trainees are supported by an ETL package that includes a curriculum for training of trainers and cascade training sessions, job-aids, and planning and monitoring tools. Grace’s story demonstrates the need for service providers to change their own behavior in order to effectively facilitate change within the communities they support.

“ETL is an invaluable approach; it puts the client at the center of the client-provider interaction,” said Hellen Mwale, ONSE Health director for community mobilization, referring to ETL’s focus on genuinely listening to community members and valuing them as resources in the behavior change process.  

Amelie Sow-Dia, PharmD., MHS, is a social and behavior change communication consultant with Overseas Strategic Consulting, Ltd.



  1. Grace is not her real name because she requested anonymity
  2. Education-Through-Listening is an innovative interpersonal communication approach developed by Dr. Bobbie Person, PhD., of the US Centers for Disease Control and Prevention, and adapted in the Democratic Republic of Congo and Malawi by Overseas Strategic Consulting, Ltd.
  3. 2015-16 Malawi Demographic and Health Survey