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Table 2 Summary of key findings.

From: Intergenerational impacts of maternal mortality: Qualitative findings from rural Malawi

Major Themes Summary of Findings by Theme
Caretaking by default after a maternal death - Female relatives from the maternal side were routinely called upon to care for orphaned children, often without having a choice in the matter.
- Maternal death often exacerbated tensions between caregivers and extended family members who did not offer support for orphaned children.
- Men frequently remarried before the mourning period ended, cutting ties with the maternal family.
Barriers to accessing high quality care - The physical and economic challenges of accessing health centers played a role both in maternal death, and the provision of follow-up care to orphaned children.
- Staffing shortages diminished the quality of care received by individuals who were able to access health centers.
- Infants faced acute needs following maternal health. While health facilities provide free milk substitute for the first six months of life, these services were inconsistently available and difficult to access.
- Older children faced health and nutritional risks related to protein deficiencies and low caloric intake.
Financial hardships for caretakers and impacts on children - Caretakers faced economic hardship, stretching limited resources to support orphaned children.
- Integrating orphaned children into a family often acted as a source of tension between spouses.
- Families often turned to short-term, informal labor, to absorb the immediate impacts of caring for orphaned children, which can limit a family's opportunities for financial stability and independence.
- Orphaned children were often called upon to take on additional household responsibilities, with preference showed towards biological children in allocation of expenses related to school and nutrition.
Loss of childhood for orphans, especially female orphans - Orphaned children faced disadvantages related to educational opportunity, when families could not afford school fees and supplies.
- Girl children were often expected to take on caretaking and household responsibilities, and faced pressures to find a partner at an early age in order to alleviate financial pressures on the family.
- Losing a mother also had informational, emotional, and social costs for girl children.
Government assistance and other support programs - Many participants did not know about support available through government institutions and NGOs.
- Those who did seek support, often felt it was ineffective, non-transparent or difficult to access.