Helping women plan their childbearing

When the monthly contraceptive injection that Linilly Juma, a mother of four, got from a public health centre in her Luwalika Village, Mangochi was out of stock, she fell pregnant with her fifth child. By the time Juma decided to pay for the contraceptive and went to a private health facility in the district, she was already four weeks pregnant.

Juma is not alone, many women like her in the country have had unintended pregnancies due to shortages of commonly used contraceptives at government health facilities.

“I went to the clinic after failing to find Depo Provera at government hospitals. When they tested me, they found that I was already pregnant. They could not put me on any contraceptive. So they counselled me and sent me home,” said Juma.

Experts have said unintended pregnancies and abortions are common in the country.

Hawa Yusufu, a married mother of three from neighbouring Ngalipa Village, said the situation there was no different from Luwalika.

“We are lucky that some health centres have the injectables in stock, but some don’t have so we are advised to try the next health centre where the contraceptive is in stock.”

She explained that contraceptive shortages were frustrating for husbands who supported their wives with family planning.

“Some men, like my husband, have begun supporting their wives in family planning. But when we go to the clinic and don’t find our preferred contraceptive (available), they get frustrated and they never accompany us again,” said Yusufu.

The 2010 Malawi Demographic Health Survey (DHS) says the country’s contraceptive prevalence rate (CPR) is at 42 percent, which means 58 percent of women need contraception, but cannot get it.

But news of the Jadelle Access Programme (JAP) is what women whose access to contraceptives is met by such challenges need. Not only does Jadelle provide women and couples with more family planning options, it also allows them to avoid the frustration that comes with frequent visits to family planning clinics that result from contraceptive stock outs.

This week, a group of public and private sector partners finalised an agreement that will make Jadelle, an effective, long-acting, reversible contraceptive implant, available to over 27 million women in the world’s poorest countries, including Malawi, at a more than 50 percent price reduction over the next six years.

JAP is developed and supported through a partnership between Bayer HealthCare AG, the Bill & Melinda Gates Foundation, the Clinton Health Access Initiative (Chai), the governments of Norway, the United Kingdom, the United States and Sweden, and the Children’s Investment Fund Foundation (CIFF) and the United Nations Population Fund (UNFPA).

According to a statement released by the partners, the JAP builds on momentum generated at the July 2012 London Summit on Family Planning, where global leaders pledged to provide an additional 120 million women in developing countries with contraceptive access by 2020.

“It also supports the recommendations of the UN Commission on Life-Saving Commodities by helping to shape global markets in order to increase the availability of quality, life-saving commodities at an optimal price and volume,” reads part of the statement.

Currently, the Ministry of Health is working on improving service delivery infrastructure and training health providers to ensure that women have safe and quality access to proper insertion and removal services, as well as counselling.

Fannie Kachale, deputy director of the Reproductive Health Unit in the Ministry of Health said JAP will help government procure Jadelle at a much lower cost.

“It will help us procure a larger amount as it is cheaper, but the onus remains on the women who use contraceptives. We only give them the information, but the choice is theirs,” said Kachale when asked on the potential impact of the JAP on Malawi.

Currently, Depo-Provera contraceptive injection is one of the most commonly used among local women.

Joyce Wachepa, senior technical adviser in family planning and reproductive health for the USAid-funded Support Safe Delivery Integration (SSDI) Services, says Depo Provera is popular because rural women find it easier to use compared to pills. Women also prefer it, Wachepa said, because they could take the contraceptive without the knowledge of their husbands.

“Jadelle is a long-acting method that can be effective for up to five years. The Jadelle Access Programme is good because if women adopt the use of Jadelle and it is working well, it can reduce frequent births, and we know the benefits of a woman not having babies frequently,” said Wachepa.

She said child spacing ensures both women and their children are healthy, which then allows women to do other things such as businesses or work, and their social lives improve.

Wachepa says currently, there are two long-acting contraceptive methods: Jadelle, and implanon, which acts up to three years.

She says they are encouraging men to be involved in family planning so that they know what is happening with their wives.

It is believed that when fully implemented, JAP will avert more than 28 million unintended pregnancies between 2013 and 2018, and, ultimately, prevent approximately 280 000 infant and 30 000 maternal deaths.

Today, over 200 million women and girls in developing countries who do not want to get pregnant lack access to modern contraceptives.

Studies have shown that of the 600 million women in developing countries who are using modern methods of family planning only one to two percent use implants, but that a significantly greater proportion would choose implants if they were consistently available and supported by counselling and clinical services.

A January 2012 document by the Ministry of Finance on Rapid Population and Development points out that future fertility depends primarily on increased contraceptive use and greater attention to population issues.

It further says increasing access to family planning can help Malawi advance towards its aspiration for a productive and healthy population.