Making contraceptives accessible

Some women in the country are still struggling to limit, delay and space childbirths not because contraceptives are unavailable close to where they live.

Rather, these sexually active citizens need an environment where no men watch when they seek contraceptives.

The fierce men include sexual partners, especially husbands.

In Galeta Village, Jacqueline Emmanuel recounts the plight of women who own two health books just to ensure no one knows what they are up to.

“One is for family planning and the other for illnesses. The one for contraception is top secret,” she says.

Afraid of a backlash from men and society, some women are afraid to walk over  five kilometres  (Km) to access modern family planning methods at Chiponde Health Centre and Neno District Hospital.

“We are always conscious. Some do not want men to know that they are on contraceptives. Others do not want the whole village to know,” she says.

But men’s resistance to family planning keeps pushing women willing to prevent unwanted pregnancies to use short term contraceptive methods.

Many settle for injectable contraceptives which are undetectable although they work for three months only.

However, the establishment of Kalioni Village Clinic by Save the Children reduced the long travels in search of contraceptives and child health.

Women have now said goodbye to the long walks that always made their spouses and in-laws to suspect the women were up to something queer.

Seeing a woman with no illness or a sick child going to the  distant health facilities made onlookers to always raise their eyebrows.

“People are inquisitive,” Emmanuel says. “They want to know why you are going to the hospital. Some women will call you lazy if you use contraceptives when you only have two or three children.”

The situation is slowly changing, as awareness increases and women access contraceptives at Kalioni and other village clinics.

Many are realising that delaying childbirth is no felony.

When asked about delays to conceive, women on injectables just say they are using natural birth controls.

Common experiences

Countrywide, long distances, myths and hostilities from spouses restrict women’s access to modern family planning services, especially long and reversible contraceptives.

Margaret Charles, from Samu Village, Traditional Authority (T/A) Kanduku in Mwanza District, unravelled the widespread misconceptions.

“Some men believe women who use contraceptives are promiscuous while others say their wives’ wombs would be harmed. They think their wives will face difficulties when they want to have another child,” says Charles.

Support from men

While some men are opposed to contraceptives, Blessings Domwe, from Samu village, is one of those who are silently changing the picture.

He explains: “When issues of family planning were new, we thought they wanted to deceive us to have few children or have no children at all.

“But health workers explained to us that child spacing helps in saving lives of mothers from deaths and complications of giving birth frequently, including termination of unintended pregnancies.”

Interestingly, Domwe knows that family planning helps parents to adequately take care of children.

He says deaths, diseases and malnutrition among under-fives are decreasing as parents sufficiently meet their food needs.

Having babies in quick succession seldom forces mothers to stop breastfeeding prematurely.

“Men, who know the benefits of family planning, now support the women in accessing contraceptives,” he says.

Interventions

Since 2014, Save the Children and the Ministry of Health have been running a three-year initiative to improve child health and uptake of modern family planning in hard-to-reach parts of Mwanza, Neno, Thyolo and Blantyre.

 They have constructed village clinics and deployed health surveillance assistants (HSAs) in remote communities to ensure women and children walk no more than five kilometres to access vital health services.

The community health assistants are trained in providing maternal, newborn, child health and family planning packages to reduce deaths and missed opportunities.

They now offer family planning services to women in their clinics.

“Apart from reducing the distance women travel to access family planning, there is also an issue of privacy,” says Peter Kasiyamaliro, HSA at Samu Village Clinic.

For confidentiality, women access contraceptives of their choice when they go to weigh their children.

 Save the Children programme manager for maternal newborn and child health Luwiza Puleni  says the project, ending in 2019, is increasing the number of women using contraceptives.

Counting gains

According to Neno District medical officer Dr Arnold Jumbe, the hilly district was left behind in terms of use of family planning.

“The situation is improving as more and more women are accessing contraceptives right in their villages. But we need to overcome the myths and get men involved,” he says.

Mwanza district health officer Raphael Piringu says there is an increase in the population of women using modern family planning methods.

“We are making gains, but there are still some  families with more children than they can effectively take care of,” he says.

Nearly 65 in 100 women in Mwanza are using modern contraception, he says.

This is slightly above the national uptake estimated at 60 percent.

“There has been tremendous improvement,” Piringu says. “Through community mobilisation and the village clinics, couples know they can limit or space childbirths using contraceptives.”  n