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The gendered micropolitics of hiding and disclosing: assessing the spread and stagnation of information on two new EMTCT policies in a Malawian village

Announcement of a new publication by Janneke Verheijen, lecturer at the Institute of Cultural Anthropology and Development Sociology.

Janneke Verheijen
05 oktober 2017
Health Policy and Planning


Analysing why certain information spreads—or not—can be highly relevant for understanding an intervention’s potential impact. Two recently implemented policy changes related to EMTCT (elimination of mother-to-child transmission of HIV) in the Balaka district of Malawi give ample opportunity to assess how new information trickles through a targeted rural community. One of the policies entails the lifetime provision of ART (anti-retroviral therapy) to all HIV+ pregnant women—a governmental strategy to EMTCT first initiated in Malawi and now being expanded throughout the region. The second new policy concerns a pilot project in which women are financially rewarded for attending antenatal care and delivering in the hospital. An in-depth anthropological approach was used to assess what women in one village community know about the policy changes and how they had come to know about it. Although the policies were implemented more or less at the same time, awareness and knowledge levels among village women differed largely: In case of the first, awareness stagnated at the level of those who directly received the information from health professionals. In the case of the second, highly accurate and up-to-date knowledge had spread throughout the village community. I suggest three reasons for this divergence: (i) perceived talk-worthiness of (issues addressed by) the interventions, (ii) motives for hiding or disclosing involvement in either of the interventions and (iii) the visibility of each intervention, or in other words, the (im)possibility to hide involvement. I argue that these reasons for women’s structural silence on one policy change and prompt sharing of information on another follow a distinctly gendered logic. The findings underline that the diffusion of new information is to a great extent shaped by the social particularities of the context in which it is introduced.