Uncovering the hidden implications of water scarcity for maternal health: a photovoice study in rural Malawi (Thyolo district)

Chiara Pittalis^1*Elizabeth Kogoya²Antonio Jaen Osuna¹Christabel Kambala²

• ¹Institute of Global Surgery, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
• ²Public and Environmental Health Sciences Department, School of Science and Technology, Malawi University of Business and Applied Sciences, Blantyre, Malawi

Introduction: Access to clean water is essential for health, but in rural Malawi, water scarcity significantly threatens the health of postpartum women and their babies. Water is critical not only for hydration but also for hygiene, preventing infections, and promoting overall health, particularly during the postpartum period. Despite women’s central role in water management within their households, they are seldom included in discussions about water access and management at the community level or within formal governance structures, where decisions are often made without their input. As climate change exacerbates water scarcity, addressing these challenges becomes increasingly urgent for maternal and child health.Goal & Methods: This study aimed to create space for postpartum women to document and share their experiences with water scarcity and its implications through participatory photography. Eight women from rural communities in Thyolo District, Southern Malawi, were trained in photography and ethics. They captured images reflecting the challenges they faced with water access and maternal health. Through gallery walks and group discussions, photovoice allowed women to share the stories behind their images, providing deeper insight into the emotional, social and health implications of water insecurity. A phenomenological analysis was conducted to interpret the photographs and narratives.Results: The women’s photographs and stories highlighted the multifaceted impact of water scarcity on health. They depicted not only the physical toll of water collection but also the emotional stress and heightened risk of infection due to inadequate sanitation. Through photovoice, the women conveyed a powerful narrative of vulnerability, resilience and frustration, revealing issues that are often invisible in traditional health research. Conclusion: Photovoice proved to be an effective tool for amplifying the voices of marginalized postpartum women, enabling them to highlight the urgent need for clean water access. This approach not only raised awareness of water-related health issues but also provided valuable insights into the lived realities of women in rural Malawi. As climate change continues to intensify water scarcity, these findings underscore the need for sustainable, community-driven solutions. The study offers a model for inclusive research on global health challenges, particularly in vulnerable communities.