Matiki who accesses self-injectable contraception from FPAM mobile clinic, says before 2018, access to injectables was expensive and hard to find. The same is also narrated by Aisha Smart, 26, and Modester Kachepa, 22.

Matiki: Preparing fire for a meal after accessing services at Ntonda – Chindongo FPAM mobile clinic

Who doesn’t want a healthy and happy family? Women from Ntonda – Chindongo in Mangochi raised a question and explained how hard it was for them to access a contraceptive method of choice before FPAM started mounting tents for mobile clinics in their area.

Clara Matiki, 24, a mother of two children recalls how difficult it was for her to penetrate a culture that dominantly discouraged the use of modern contraception and worse more, there was no adequate supply of contraceptive commodities. “There was great opposition from family members and friends stating that there is no point in jumping into modern contraception. Some people here still believe in traditional contraceptives like Nkuzi (thread cloth) which women wear around their waist. The tied knots represent the number of years they are protected from unintended pregnancy. However, this has disappointed many girls and women as they end up pregnant when they actually prepared to stay for 4 years without a child for example. I discourage my friends to go for such birth controls because they’re not reliable,” said Matiki.

“By 2013, every time you go the Health Surveillance Assistant (HSA) for Depo injectable, you could find the cooling box already empty. We had to buy injectable contraception at MK300 every three months at a private clinic and transport cost was then MK200. It was just expensive. Many women and girls would not afford this and unintended pregnancies were unimaginable. By 2020 I opted for Jadelle implant through FPAM clinic and I still patronize such clinics for other services like HIV testing and cervical cancer screening apart from escorting women I convince to seek family planning services,” said Smart.

A mother of two children at the age of 22, Modester Kachepa finds that it’s very hard to have many children while still young and economically unfit. “At 16 I gave birth to the first child. It was not easy to access injectable contraception from our community health workers as they continuously reported commodity stockouts. Buying injectable contraception from a private clinic at MK500 and transport at MK400 transport was the only and exorbitant option available to those who dearly chose to delay first pregnancy or champion birth spacing,” Kachepa said.

The women showed that youth club information sessions, community dialogues, health education with their Health Surveillance Assistants (HSAs), and radio spots are the key sources of family planning information that help to promote access to sexual reproductive health services at both static and mobile clinics. “While at Chindongo youth club, some girls who had not even given birth informed me about long-acting and reversible contraception that are for free at FPAM mobile clinics. At 17 I got my first three-year implant and recently after giving birth to the second child, I have opted for a five-year implant from the same mobile clinic at Chindongo,” Kachepa explained.

The main reasons that have motivated youth, women and men in Ntonda area to break the cultural and religious barriers toward increased use of sexual reproductive health services include family good health, time for education completion and time for family economic activities. “I now go to school to get better Malawi School Certificate of Education (MSCE) points. My children are well spaced, are in primary school and they are healthy,” Matiki said. “I’m able to attend to development activities because I spaced my children well. My husband also finds me still beautiful and adorable because I’m able to maintain my beauty due to good health and he encourages me to stay on the implant,” she added.

“I’m able to take care of my two children through powdered soap and fish selling businesses, how could I with ill health?” asked Smart. “Some women have adored me for looking good and always active in managing my home. And they have become promoters of family planning too,” Kachepa added.

Kachepa: Receiving family planning services at Ntonda  – Chindongo FPAM mobile clinic

Clara Matiki, Aisha Smart, and Modester Kachepa have not bounded the benefits of family planning to themselves. They have embarked on voluntary services to inform, educate and refer their peers to the service delivery points where they get counselling and health services of their choice.  Kachepa stressed that “My cousin couldn’t give an ear to modern family planning issues until she learnt why my health was in good shape when I opted for an implant. Today she is a testimonial of implant contraception and she is sharing such good news with her peers,” she said.

Mangochi district has a rich history of being religious with the majority of Muslims seconded by Christians. However, the flow of family planning information through media, community engagement activities and health education at all service delivery points over time has seen Islam and Christian religious members supporting youth and community access to sexual and reproductive health services which were previously highly demonized.

“I have seen many girls die due to unsafe abortions, birth complications but also ill health because young girls cannot afford to carry the pregnancy. They burden parents who are already poor to take care of an extra family member as most girls do not married after giving birth due to child marriage restrictions and lack of commitment from boys and men to shoulder paternal responsibilities. This made me to start door to door youth and parent’s sensitization to promote youth access to contraceptives to prevent both teen pregnancies and sexually transmitted infections. With help from Getrude Kachepatsonga, our Health Surveillance Assistant (HSA), I have managed to counsel and refer 74 girls from our Bakili village and other surrounding villages to FPAM mobile clinics and community health workers for different health services,” said Amina Rashid, 44, Ntonda Anglican Church Mother Union member.

Rashid: We promote good health in church, so every person of reproductive age has to access required health services

Rashid added that most youth would not be motivated to walk 8-15km to the nearest health facility from our area. That’s why mobile clinics are the first option to help most youth access health services on time.

“As a matron of Chindongo youth club, we encourage youth to attend youth club information sessions because they engage health workers who provide accurate and adequate family planning information and successful referrals. Most youth have benefitted from such meetings as we rarely hear school dropouts due to teen pregnancies,” said Marriam Chipala, 34, Ntonda Muslim Women Brigade member.

Traditional leaders are also on the lead to ensure every household is accessing health services. “We use church, mosque, funerals, and wedding spaces to inform communities about available health services at mobile clinics. We have seen most parents and guardians allowing their wards to access all sexual reproductive health services including HIV testing and counselling and contraception services. Community acceptance is high now,” said Emmanuel Kaizi, Senior Chief Counsel of Group Village Head (GVH) Chindongo of Senior Chief Nankumba in Mangochi.

The only community health worker who works as a Health Surveillance Assistant (HSA) in Chindongo area under Nkope health centre, Getrude Kachepatsonga, appreciates that the community has massively improved in adopting a health service-seeking behaviour. “By 2005 when I was posted here, people were not easy to convince to prioritize health and hygiene issues. Through continuous community dialogues and support from FPAM mobile clinics, parents and guardians have acknowledged the importance of good health in families of which prevention of unintended pregnancies and sexually transmitted infections are part of the game. Imagine, since 2005, Ntonda has never been hit again with Cholera, and the number of girls falling pregnant is also decreasing,” she said.

FPAM is implementing SRHR integration project in Mangochi through the UNFPA fund, responding to a need to lower the pregnancy proportion rate of 29% among teens between 15-19 years and ensure men and women of reproductive age have access to quality health services by 2030 through Sustainable Development Goals 3 Good health and wellbeing and 1 No poverty