The push toward universal coverage of long lasting insecticide-treated bed nets (ITNs/LLINs) does not negate the fact that pregnant women are still a more vulnerable group that needs protection from anemia and death themselves and miscarriage, low birth weight and greater infant and child mortality for their offspring. So far the data on net coverage for pregnant women is not encouraging. Nets are extremely important because they are the one safe malaria control intervention that women can use right from the start of pregnancy.
Recent Demographic and Health and Malaria Indicator Surveys (DHS and MIS) show a common problem.Â The graph here shows general access to LLINs is low (orange bars) in many countries relative to the Roll Back Malaria target of 80% coverage by 2010. What is of equal concern is that even when households possess nets, pregnant women do not always use them (blue bars).Â Rwanda with its strong national network of community health workers is the exception. What is discouraging women?
The Liberia MIS asks why people do not own nets, and since these surveys prioritize interviewing women of reproductive age, we may assume that these reasons express the views of women.Â A few do not perceive mosquitoes to be a problem (especially in the dry season), some simply do not like to sleep under nets while others complain of the cost.Â The latter is curious because nets are primarily provided for free these days.
Clearly we need more information on the dynamics of net use at the household level.Â Field visits after a universal coverage campaign in Akwa Ibom State discovered that women themselves see alternative uses of for nets.Â One picture shows LLINs covering vegetable gardens that are tended by women in this community. Maybe they believe the nets will keep insects off their vegetables, although the sun will soon render the insecticide ineffective.
Another picture shows that a woman has protected the wares in her small kiosk buy covering it with a LLIN. Customers can still see the wares but insects can’t nibble at the food items on sale (nor children easily pilfer some).
Both of these examples highlight the economic roles of women in the community. Are women making net decisions on their perceptions of what is in their best economic interest? In most communities in Nigeria, income from a woman is crucial to the welfare of her child.
The issue of nets for pregnant women will be one of the issues discussed during the upcoming summit, Malaria in Pregnancy: a Solvable Problemâ€”Bringing the Maternal Health and Malaria Communities Together, a meeting in Istanbul, Turkey, June 26-28, 2012, organized by the Maternal Health Task Force at Harvard School of Public Health.Â We will be covering the deliberations as they unfold.