Safeguarding a future workforce

At Chintheche Health Centre, health workers are inundated by teen pregnancies. Livingstonia Synod Aids Programme (Lisap), which is striving to combat high rates of school dropouts and early marriages in the shoreline part of Nkhata Bay, reports midwives at the healthcare facility had seen about 94 by June this year—with a likelihood of hitting 100.

“There is need for serious intervention to end this worrisome trend,” says Lisap deputy director Lazarus Harawa.

According to social welfare officer Lickson Ng’ambi, nearly 38 out of 100 school-going girls, aged below the legal marriageable age of 18, have their future in limbo due to early marriages this year. He spoke of girls from poor background being increasingly engaged in intergenerational relationships with fishers and tourists double their age or older. She also decried an influx of under-age sex workers across the tourism destination.

Yet, every child born to a teenager tells a story of risky sexual behaviour, especially unprotected sex which exposes them to sexually transmitted infections (STIs), including HIV and Aids.

The pandemic is one of the silent tragedies facing the country’s predominantly youthful population, estimated at 16.3 million with an average woman expected to have about five children in a lifetime unless they use contraceptives.

The young majority is the worst hit by HIV infections. According to National Aids Commission (NAC), one person in every 10 Malawians are living with the virus which causes Aids.

The countrywide survey highlights the burden of unprotected sex: in every 100 pregnancies, 25 are teens.

Lately, experts have been talking about population dividend—a window of opportunity and economic benefits that can arise when a country invests effectively in transforming its ballooning youthful population from a curse to the blessing that income generating citizens present. In their talk, they envisage sustained empowerment initiatives, birth control, education and employment overturning the bulging burden of youth unemployment and broadening the proportion of working-age citizens.

According to UNFPA population and development specialist Bill Chanza, the desired is neither automatic nor guaranteed, but will require years of political will, strategic planning, a departure from big families to smaller ones and huge amounts of resources going towards uplifting the youth.

In an interview, he explained: “The demographic dividend is about actions to empower, educate and employ the youth. It’s a long-term, complex process. Current and future leaders must buy into this idea.

“It took decades to happen to Asia, but it begins with good governance as well as laws and policies to modify fertility norms, address gender disparities, keep girls in school and empower the youth to make decision on the timing, spacing and number of children.”

However, widespread joblessness and shortage of skills are not the only factors pushing girls into high-risk tendencies, especially transactional sex in times of HIV and Aids.

Creating the health workforce the country needs is also hit by poor access to correct sexual reproductive health information as well as condoms which reduces chances of STIs and unwanted babies if used correctly.

But effects of scanty investment in the youths wellbeing usually pile pressure or the healthcare system already sagging under HIV and Aids-related ailment.

In 2005, the year the country started administering free antiretroviral drugs, NAC figures offered a glimpse of the shock: nearly 100 000 Malawians were contracting HIV annually, of which at least half were the youth aged 15-24; about 90 000 death were occurring every year; and up to 70 in 100 hospital beds were occupied by people with HIV-related illnesses.

Government credits the scaling up of life-prolonging drugs with lessening the death toll, but it remains a fragile miracle because it hugely depends on Western donors.

In fact, it is solely funded by the Global Fund to Fight Aids, TB and Malaria, making it prone to stock-outs and dosage sharing the size witnessed in 2010-12 when Western donors froze aid due to poor governance in the country.

According to a factsheet by Doctors Without Borders, the single-donor system requires government to make tough choices.

Presently, public hospitals provide first-line ARVs treatment, Tenofovir, to patients with CD4 count less than 350 according to WHO guidelines. However, only a selected people living with the virus, especially pregnant women and children under two, TB patients and those with severe side-effects, receive the ARVs credited with increasing life expectancy.

To protect newborns from contracting the virus from their parents and to improve maternal health, Malawi became the first country worldwide to ensure instant ARVs for all HIV positive pregnant women and breastfeeding mothers.

The targeted feat means the youth, especially boys and girls, are excluded from the ground-breaking antiretroviral therapy.

On August 28 last year, President Peter Mutharika became the 16th president to sign up to the ‘Protect Your Goal’ campaign UNAIDS is jointly implementing with NAC, joining what United Nations resident coordinator Mia Seppo calls a groundswell of support for access to youth-friendly sexual and reproductive health services.

“To effectively mobilise uptake of these services by our young people, we must devise innovative ways to reach young people where they spend most of their time – and these places include sports arena, schools, recreation centres and the media,” said Mutharika in his promise to the African Child.

A year on, Eva, the girl we met on the shores of Lake Malawi in Nkhata Bay pointed to a prevalent dilemma the youth face. The 20-year-old says the most predictable thing about being a girl in the Malawian cultural context is that the future is completely unpredictable.

“If you don’t contract HIV, you will get pregnant,” she says. “How can one go to health facilities to collect condoms when with onlookers seemingly saying: ‘your parents must know this? What about ARVs when some people, including health workers, seem to think we are prostitutes paying for our sins?”

Widespread stigma that scares people from accessing sexual and reproductive health services compelled health facilities to set aside youth-friendly corners, complete with games, TVs and sports courts.

Here, babies are supposed to be blessings, but Eva terms hers a little mistake. He was born when she was in Form Three, thanks to peer pressure from her classmates who told her sweet sadyera mpepala (you don’t eat a sweet without peeling off the wrapper)—meaning one cannot get a real feel of sex with wearing a condom.

That could be the day the sex workers got pregnant or/and HIV.

Now she is a sex worker. Not a bartender. Not a frequenter of bars and lodges. Not even one of the street-corner girls you encounter in the nightlife culture of Lilongwe and Blantyre. She is a home-based girl who calls herself a daughter of devoted believers.

“You come here to work or to relax and I come here to look for customers. I have a home, good parents and a child. But I have no job and money,” she says.

In Trying to Survive in Times of Poverty and Aids, Dutch researcher Francine Van den Borne argues “the effort to survive” is the major driver of people having more than one sexual partners—a tendency which is fuelling HIV infections in southern Africa.

Save for a pursuit of adventure and prestige, at-risk girls waiting for tourists in Nkhata Bay talk about destitution—poverty, orphanhood, unemployment and marriage breakups.

Nkhata Bay District commissioner Alex Mdooko says the struggle against poverty is not a good reason for girls below 18 to end up pregnant and married or HIV positive, explaining: “Some of them lack parental care and would be in school if their parents took time with them to talk about sexual issues properly.” n