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Pregnant Women

In Malawi, far too many women face preventable risks during pregnancy due to cost, distances to health facilities and lack of timely information which leads to delayed care. These barriers often result in life-threatening complications, especially in rural communities where access to skilled health workers and emergency services is limited. Our mission is to change this reality by meeting women where they are, bringing health care directly to their homes through our Proactive Doorstep Care (PDC) model and walking with them through every stage of pregnancy with compassion and continuity.

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Our care for pregnant women begins with early identification during home visits by trained Community Health Workers (CHWs). Once identified, expectant mothers are enrolled into regular antenatal support where Nurses on Bikes provide vital services: health assessments (blood pressure, anemia checks, fetal growth monitoring), nutrition counseling, malaria prevention and birth preparedness planning. Women receive education on pregnancy danger signs and are supported to create safe delivery plans, including referrals to health facilities when needed. As delivery approaches, we ensure women have access to skilled birth attendants and ambulance support for emergencies. After childbirth, the mother and newborn continue to receive postnatal follow-up, including breastfeeding support, family planning counseling and mental health check-ins, to ensure a safe recovery and healthy start to life.

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A Step-by-Step pdc care

Pregnancy Identification (0–12 weeks)

Goal: Early detection of pregnancy to initiate timely care


Key Actions:

  • CHW conducts routine household visits.

  • Pregnancy is identified through self-report or CHW-administered test (where necessary).

  • Woman is enrolled into Wandikweza’s Pregnancy Register and assigned a Nurse on Bike contact.

  • Health education begins immediately on:

    • Importance of early antenatal care (ANC)

    • Nutrition and hydration

    • Danger signs (bleeding, dizziness, fever, etc.)

  • CHW supports woman to attend her first ANC visit at facility.

First Trimester (0–13 weeks)

Goal: Establish care, provide foundational health education


CHW/NoB Visits: 1–2 home visits

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Key Focus Areas:

  • Facilitate timely first ANC visit

  • Assess nutrition, mental well-being, and social support

  • Educate on:

    • Early fetal development

    • Avoiding harmful substances (alcohol, smoke, herbs)

    • Managing morning sickness

    • Safe medication

  • Administer or refer for:

    • Iron/folate supplementation

    • Malaria prevention (IPTp when appropriate)

    • HIV testing and counseling (HTC)

  • Begin birth planning conversation (where to deliver, who will support her)

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Second Trimester (14–27 weeks)

Goal: Ongoing monitoring and birth preparedness


CHW/NoB Visits: 1 per month (minimum 2 visits) 

Key Focus Areas:

  • Continue health education:

    • Danger signs (swelling, headache, decreased fetal movement)

    • Nutrition (emphasis on local foods, protein, iron)

    • Rest and stress management

    • Family planning after delivery

  • Encourage second ANC visit (and third if possible)

  • Monitor: by NoBs

    • Blood pressure 

    • Fetal movement

    • Weight gain and signs of complications

  • Create or review birth plan:

    • Facility identified for delivery

    • Emergency contacts and transport plan arranged

    • Prepare supplies: clean cloth, baby clothes, maternal items

  • Engage partner or family in maternal support education

Third Trimester (28–40 weeks)

Goal: Ensure mother is ready for delivery and complications are anticipated


CHW/NoB Visits: 2–3 home visits, spaced every 2–3 weeks

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Key Focus Areas:

  • Finalize birth preparedness

  • Reinforce facility delivery importance

  • Confirm transport options and contact facility if risks identified

  • Prepare for potential complications:

    • Preeclampsia

    • Preterm labor

    • Malaria in pregnancy

  • Mental health screening: anxiety, depression

  • Educate on:

    • Signs of labor

    • Breastfeeding preparation

    • Newborn danger signs

    • What to bring to the facility

  • Emergency plan activated if any high-risk factors appear

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Delivery Support (40 weeks ±)

Goal: Ensure facility-based, safe delivery with skilled care


Our key role:

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  • CHW/NoB activates referral or community transport if labor begins

  • Ensure woman reaches designated facility (can be health centre or hospital)

  • CHW may accompany if needed or stay in communication with family

  • Monitor if complications arise; liaise with facility nurse/midwife

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