Childbearing by choice

When founding president Hastings Kamuzu Banda opened Salima District Hospital in 1989, five women were giving birth there every day.

Almost three decades on, up to 30 babies are born every day at the hospital, which serves a population of about 450 000.

Like most districts, the shoreline setting is grappling with rapid population growth and low uptake of modern family planning.

In primary schools, 16 percent of girls sit Primary School Leaving Certificate of Education (PSLC)examinations. Many drop out due to early pregnancies, early marriages and financial constraints.

In 2015, Elizabeth Patrick, a Standard Seven pupil from Ngwata Village, Traditional Authority (T/A) Mwanza, got pregnant aged 15. She was not pushed to marry. Instead, her mother, Alice Arnold, cared for her until she gave birth.

“After giving birth, Elizabeth returned to school while I continued taking care of the baby who is now a year and eight months old,” says the mother of five.

Now, Elizabeth is in Form One at Bilira Secondary School. The school girl is convinced that she would not have fallen pregnant, which slowed her education, if she had access to sexual and reproductive health rights (SRHR) services and information.

According to United Nations Population Fund (UNFPA) resident representative Young Hong, family planning allows women and girls to decide when to have a child, the spacing and the number of children.

“Family planning is all about options,” she says. “The options women can find and exercise suiting their family condition and their own ambitions as well as resources. It is very important for the development of women.”

UNFPA is working with government to promote SRHR, including voluntary family planning, so that every person of reproductive age accesses information and services—and knows where they can get the services and how.

“We are trying to expand and ensure universal access. Youths do not have to travel miles and miles to get condoms or contraceptives because over time people give up access to family planning methods. So we are trying to bring the services closer to them; make information available for them and be able to get whatever social assistance they need,” says Hong.

Despite the unmet demand for SRHR information and services, Salima district youth-friendly health services coordinator Lyton Chithonje says most parents do not want their children to be exposed to such information and services.

“We have a special day and session every week when we talk to the youth about SRHR. We also have a special youth-friendly health services corner[YFHS] where they can go for any information, HIV testing and counseling (HTC) as well as to access family planning services. But most parents do not want their children to access such information or services. They argue that it is for older people,” he says.

Salima comprises a diversity of cultures—uniting the Yao, Ngoni and Chewa—which discourage girls from using contraception, but tolerate child marriages.

“For instance, some parents offer their 12-year-old children for marriage to people based in South Africa. Upon returning, no matter how old the child is at that time, will marry the worker. The parents just want money,” Chithonje says.

For district medical officer Dr George Kasondo, it is not easy for health workers to provide SRHR services. They always have to be senstive to cultural norms when disseminating vital messages to the youth.

“Ultimately, we want to see a reduction in early pregnancies so that we can avoid maternal deaths happening because of immaturity of the adolescent girl’s body. We want to see children stay in school until their dreams come true,” he adds.

The 2017/18 Health Sector Performance Report shows that  most health facilities in the country run out of family planning commodities due to procurement delays. This presents a setback to access to family planning.

At worst, it results in unintended pregnancy, unsafe abortion and sexually transmitted infections, including HIV.

“Girls are risking their lives because information is not available. So we are working with government, within the legal boundaries, to prevent the unfortunate deaths resulting from illegal and unsafe abortions,” says Hong.

She points out that the best way is ‘condomising’ and preventing unplanned and undesired pregnancies through contraceptives.n