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Keywords:

  • [risk;
  • malaria;
  • sexually transmitted illnesses;
  • pregnancy;
  • structural factors;
  • Malawi]

Findings from a study designed to discover how local understanding of malaria among Yao in Malawi relate to pregnancy risk definitions reveal that malaria in pregnancy is not perceived as a major risk. Using extended ethnographic field research and multiple methods, we argue a shift from narrow single-disease approaches to malaria during pregnancy is required and document women's concerns about exposure to multiple vulnerabilities during pregnancy, including witchcraft, extramarital affairs, and multiple dangerous illnesses. Four dimensions are implicated in Yao perceptions of risk: perceived adverse consequences in pregnancy; ease of treatment and cure; transmission and agency to control; and type of risk (social–medical). We discuss implications and consider malaria program features needed to address the complexity of perceived vulnerabilities and living conditions in resource-poor settings.