On November 1 2018, 15-year-old Sovenia Yusuf lay writhing in agony in a maternity wing at Lulanga Health Centre in Mangochi North. For 19 hours, she was in labour pains.
This was her second day at the facility. She was taken to the facility on a bicycle stretcher by well-wishers from her community in Kumbani Village in Traditional Authority (T/A) Makanjira. The village is located over 10 kilometres (km) away from the health centre.
According to one nurse at the facility, Foseka Chowe, the teenager had to persevere delayed labour pains due to her tender age.
“She was set to deliver nine hours ago, but she is experiencing obstructed labour. In this case, we have to refer her to Mangochi District Hospital,” said Chowe.
Outside the small maternity wing, which has only two beds but at times can hold as many as 20 expectant women, was Sovenia’s mother, Lubia M’balaka. She was sweating profusely fearing for the life of her daughter who got pregnant while in Standard Seven at Maganga Primary School.
The wait for an ambulance continued beyond 3pm, about nine hours after the expected time to deliver. Time was running out for Sovenia.
The ambulance arrived at 4pm and the teenager was to withstand another four hours on the 130km bumpy dusty road to Mangochi District Hospital.
“If I had money, I would have hired a taxi,” said the mother. “I fear for the life of my daughter.”
The same day, Sovenia delivered a baby boy though with hardships.
Her story mirrors the situation on the ground. Many girls who fall pregnant while young undergo adversity to deliver.
In 2015, Bertha Limbuli, a teenager from Ngaliya Village in T/A Nkhulambe in Phalombe nearly died due to labour complications.
“After 18 hours, I was referred to Phalombe Health Centre from Nkhulambe for caesarian section. The experience left me with obstetrics fistula,” she recalled.
She was treated for fistula at Bwaila Hospital early this year.
In Blantyre, Beatrice Milowa, 17, spent 11 hours at Luwanda Health Centre in Blantyre before being referred to Queen Elizabeth Central Hospital (Qech) due to labour complications. She later delivered through caesarian section.
Ministry of Health spokesperson Joshua Malango admits increased teen pregnancies and deliveries. He says the common teenage labour complications are obstetric injuries
“Vaginal fistula is the most common. Of all vaginal fistula cases recorded, 51 percent are teenagers,” he says.
According to the 2016 Demographic Health Survey (DHS), Mangochi tops in teenage pregnancies at 37 percent.
Sub-T/A Lulanga youth facilitator Thokozani Banda says nsondo and jando are some of the factors fuelling teenage pregnancies in Mangochi.
“In the past, the initiates were adults, but now it is children. Thus, the messages they receive is intended for old people,” says Banda.
Chief Lulanga also brings another dimension to the problem. He says girls fall prey to young men, who go to South Africa to work.
“When these young men come back, they bring gadgets such as phones which lure girls,” says Lulanga.
Mangochi deputy district family planning coordinator Margaret Nyalugwe notes that as a lakeshore district with many fishing grounds, it disadvantages girls as fishers entice them with cash.
Lulanga Health Centre provides services targeting mainly the youth to address teen pregnancies. There are two health surveillance assistants (HSAs) engaged in this initiative. They provide family planning services and protect youths from unwanted pregnancies.
“In addition, we have formed clubs which spread family planning and HIV and Aids-related issues to schools and communities,” explains Stiya Guma, one of the HSAs.
Sub-T/A Lulanga has also formulated by-laws banning child marriages in his area to complete the initiatives.
“Any family that marries off a child is fined heavily,” he says.
With these interventions, Nyalugwe says there is an improvement on the uptake of family planning methods in the district.
“Now more teenagers are using family planning methods as compared to the past. Almost 50 percent of the people who patronise health facilities in the district are the youth,” she says.
What Mangochi is doing is what you get in districts such as Zomba, Phalombe, Ntchisi and Chitipa, among many other districts, but the story on the ground indicates increasing teen pregnancies.
Statistics indicate that teenage pregnancies are at 29 percent, an increase from 26 percent in 2010.
In 2016, Malawi passed the Child Protection Act which set the marriage age at 18 as one way of ending child marriages, but it seems poor implementation has rendered the Act toothless.
As Malawi continues to search for lasting solutions to teen pregnancies, Sovenia’s prayer is that no child should go through what she experienced. Nineteen hours in labour is torture she will never forget. n