Mandating that women deliver in health centers without traditional birth attendants violates women's rights, as stated in The Declaration of Lisbon on the Rights of the Patient, at https://www.wma.net/policies-post/wma-declaration-of-lisbon-on-the-right.... Among the Principles in that document: "2. Right to self-determination: (a) The patient has the right to self-determination, to make free decisions regarding himself/herself. The physician will inform the patient of the consequences of his/her decisions; (b) A mentally competent adult patient has the right to give or withhold consent to any diagnostic procedure or therapy..."
It's not only a matter of human rights (which is enough of a reason by itself) but also women's safety. Because deficiencies in standard precautions in health facilities have not been adequately addressed in Malawi (as well as in many many other countries), mandating women to deliver in health facilities may be subjecting them to risks, including nosocomial infections. Women should be allowed to decide for themselves where they feel safe. One way to get more women to choose -- of their own accord -- to deliver in health facilities is to make facilities safer, including investigating evidence of nosocomial transmission to find and stop the problems.
HIFA profile: David Gisselquist is an independent consultant in the United States and has a professional interest in nosocomial risks and transmission of HIV in Africa, agricultural development and agricultural inputs regulation, environment. Email address: david_gisselquist AT yahoo.com