Winding road to family planning uptake


The road to Usisya is perilously mountainous and bumpy. It is a single lane road dissected by several streams, snaking through an escarpment that separates the breathtaking shoreline area from Nkhata Bay Boma, and Mzuzu City.

After the risky travel appears a beautiful small rift valley, lying comfortably on the foothill of Nthwezulu Mountain, as if breathing life from the fresh waters of Lake Malawi.

Usisya, north of Nkhata Bay, forms the end of the 60-kilometre road network from Mzuzu, although it has neighbours further north—Khondowe, Ruarwe and Mtawa.

Usisya Health Centre  supports many people in surrounding areas
Usisya Health Centre supports many people in surrounding areas

These are, however, at the mercy of boats or a ship because, geographically, they are isolated in places vehicles cannot reach.

That is a way of life for the people of Nkhata Bay North, but, in as far as health facilities go, it has proved to be costly.

“For three months now, no outreach programme has reached us here,” says Justice Chitete, a nurse at Usisya Health Centre.

The reason is that Nkhata Bay District Health Office (DHO) lacks funds to offer healthcare services; hence, the suspension of outreach programmes, he says.

Recently, Nkhata Bay DHO Albert Mkandawire told journalists that to provide proper health care across the district, his office needs over K500 million ($892,857), but government only allocated K150 million in the 2015/16 budget.

Has been abused by locals: Munthali
Has been abused by locals: Munthali

He said with just a month into the financial year, the low allocation has seen the hospital struggling to run outreach clinics, ambulance services, feed patients and other activities.

In Nkhata Bay North, this has affected delivery of family planning services, resulting into low uptake of contraceptives, especially long term ones.

“As you might be aware the DHO has suspended outreach programmes due to lack of funding. This has affected issues of family planning here because we can’t reach individuals in the remotest hard-to-reach areas,” says Chitete.

To make matters worse, secrets, myths and cultural beliefs in the area are also said to be frustrating efforts in scaling up uptake of family planning methods.

Malani Munthali, a nurse who has been in the area for three years, has suffered abuse several times at the hands of local people for administering contraceptives to a woman without the consent of the husband.

“This was not once or twice, but several times,” says Munthali who has now been transferred to Nkhata Bay District Hospital.

Munthali says women take contraceptives without knowledge of husbands, and it becomes hell when the husband finds out about the woman’s secret undertakings.

“Uptake of family planning is very low at Usisya. For example, implants are supposed to last for five years. But within a year, women come back together with husbands, asking for suspension of the method.

“We suffer abuse in the process because the husband is usually not consulted,” says Munthali.

In the area, most people believe in travelling to Tanzania for jobs, and those travelling away are not willing to have their wives undergo long term methods of family planning.

“They don’t see any sense for a woman to undergo family planning when they will not be around. They are afraid that the method might be a licence to promiscuity,” he says.

Nationwide, contraceptive use has risen markedly in recent years. The 2010 Malawi Demographic and Health Survey (DHS) reported that 46 percent of Malawian women ages between 15 and 49 in marriages were using a method, with 42 percent using modern methods.

Despite this increase, 26 percent of women, who are exposed to the risk of pregnancy, are not using any method even if they want to avoid the next birth.

Population experts observe that if contraceptive need is met among women will lead to lower fertility and a lower rate of population growth, which if remain unchecked will see the country’s population move from the current 16 million to 38 million people in 2040.

“To satisfy unmet need, a comprehensive strategy is needed to enable couples and individuals to achieve their reproductive intentions. The primary strategy is to provide universal access to high-quality reproductive health information and services,” states a government’s book Rapid Population and Development.

But people in Usisya are unable to have universal access to reproductive health information and services due to reduced funding.

Director of policy in the Ministry of Health (MoH), Dr Dominic Nkhoma, admits that all health demands cannot be met because the National Budget is under extreme pressure from other equally competing demands.

He says the MoH, through its Health Sector Reforms, is proposing for the establishment of a health fund to complement the National Budget in offering quality and effective health services to everyone.

“About 80 percent of the country’s health sector resources are concentrated on HIV and Aids, Malaria and maternal health issues which are essentially preventable conditions.

“There are substantial shortfalls to be covered by government for it to provide satisfactory health services to the population as is demanded by every Malawian.

“As such, a task force has been set up to review all knowledge around this subject [health fund] internally and externally and advise on the specifics of this fund such as the sources of revenue, organisational structure, operating principles and oversight structures,” he said. n

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