By Faith Kamtambe Kadzanja

According to UNFPA, Malawi is one of the countries with highest number of adolescent mothers in Africa. These are mothers, whose ages, range from 10 to 19 years. Out of every 1000 babies, that are born from adolescent mothers in Africa every year, 136 of them, are born in Malawi.

Although Malawi registers such high numbers of adolescent mothers, adolescent pregnancies are associated with risks of maternal deaths and other neonatal complications. The United Nations recognizes adolescent pregnancies as a significant health concern and a key objective in the United Nations Sustainable Development Goal.

Birth control, which is also known as contraception, is the use of medicines and other methods to prevent pregnancy. UNFPA Malawi website indicates that contraceptive prevalence rate among the adolescents in Malawi is as low as 37.5 percent. Further, the unmet need for family planning remains at 18 percent, with a higher unmet need for adolescents and young people at 23 percent.

Several factors contribute to the low contraceptive prevalence rate in Malawi. Some of these factors are inadequate education on comprehensive sexuality and misconceptions.

To improve access to comprehensive Sexual and Reproductive Health and Rights services among adolescent girls and young women in Malawi, a project called Her Future, Her Choice was launched in 2019. The project which will run up to March 2024 is being implemented in Lilongwe and Balaka districts, in the central and southern regions.

Family Planning Association of Malawi (FPAM), with funding from Canada’s Foreign Policy — Global Affairs Canada through Oxfam in Malawi, is implementing the project with other partners, including the Centre for Alternatives for Victimized Women and Children in Balaka and Point of Progress in Lilongwe.

The project promotes knowledge on provision of gender-responsive and youth-friendly comprehensive sexual reproductive health services among health service providers.

It also helps to improve the ability of health systems and institutions to provide gender-responsive, youth-friendly comprehensive SRH information and services.

FPAM concentrates its efforts on service delivery. FPAM District Manager in Lilongwe, Chipiliro Chiponda says the project has seen more adolescent girls and young women accessing comprehensive sexual and reproductive health information and services through targeted mobile outreach clinics in the district.

“There are some myths and misconceptions around modern family planning methods which is a major challenge and so far, we have been able to reach over 45,000 adolescent girls and women but if they were no such myths existing, we could have reached many with these services,’’ he said.

What Chiponda says is quite evident from the testimonials of clients and beneficiaries.

A Lilongwe based young mother Debora John (not real name) aged 17 got pregnant while in Form one after giving birth at the age of sixteen.

“I noted that the man who got me pregnant did not want to help so my mother encouraged me to come and access a family planning method, so I chose Jadelle.’’

“At first I was afraid considering the things I used to hear about modern methods of family planning, but it has been six months now ever since I took this method and I am okay,’’ she explained.

Debora receiving a service at an outreach clinic in Lilongwe

Jennifer Maulidi aged 18 and based in Balaka also conquers with Debora.

 “My preference is oral contraception. I take them a very day and have not encountered any challenges ever since,’’ she says.

FPAM service provider in Lilongwe, Moses Machaka says outreach clinics, have motivated many young people to access the services family planning services.

“Mostly the outreach clinics are patronized by adolescent girls aged between 15 to 25,’’ he says.

Through the project, FPAM, had identified Community Based Distribution Agents (CBDAs) who play an important role in reaching out to people in the community.

The agents provide counseling on modern methods of family planning and distribute contraceptives to people within their communities.

The CBDAs also benefited from the project. They received bicycles to ease their mobility.

“We encourage young mothers to return to school after they give birth. We just encourage them to use modern methods of family planning,’’ she says.

Balaka is one of the districts where the project was implemented. In Balaka, a lot of cultural norms, such as initiation ceremonies, encourage adolescent girls to start engaging in early sexual activities, leading to teen pregnancies. The chiefs, being custodians of culture, were also not left out.

Village head chibwanamsamala of Msamala village in the Area of Traditional Authority (T/A) Amidu says the project has also helped to eradicate some bad cultural practices.

“There is a cultural norm known as Ndakula where young girls when they have come of age pass through. After being alerted of dangers of such norms in the Her Future Her Choice project, we have been on the ground alerting the community dangers of such a norm,’’ he says.

Happy with the project – Village head chibwanamsamala of Msamala Village

Considering that members of the clergy are also quite important in society, the project also engaged them as agents of change.

Sheik Hamdan Juma of Msamala Vilage in T/A Amidu says there has been a tremendous change in as far as access to contraception is concerned.

“Even the Quran encourages child spacing so we totally agree with what the organization is saying on the need for family planning. We most of the times hardly understand issues of modern family planning, but now we have been enlightened and many of our women and young people are using the methods,’’ he says.

FPAM is implementing the project in the district in collaboration with the Center for Alternatives for Victimized Women and Children (CAVWOC). CAVWOC concentrates its efforts on alerting communities to issues regarding comprehensive sexual and reproductive health rights.

Many young girls in the district testify to have benefited from the project. The say that at first, they perceived contraceptive usage as a reserve for married couples. This, they say, led to the low uptake of the contraceptives, resulting in many teenage pregnancies.

Bibiyana June not her real name, says the project has helped her fellow peers with necessary tools to make it in life. She says at her youth club and at school they encourage each other to demand for services.

“I usually get condoms from the mobile outreach clinic. I want to be a nurse some day and I can only achieve this by being careful,” she says.

FPAM service provider in Balaka Melia Wella says the mobile outreach clinic has been a great tool as far as the provision of family planning methods is concerned.

“There is a lot of change in altitudes and uptake of sexual reproductive health services,’’ she says.

Wella counselling clients on modern family planning methods

Nurse midwife technician at Kalembo Health Centre, which is under Balaka District Health Office, Jire Sam, echoes with Wella.

“Our youth had problems with family planning, they did not have knowledge on available family planning methods so most of them we engage in early sexual practices resulting in abortions,’’ she says.

FPAMs project coordinator Jimmy Kachale says many health workers in Lilongwe and Balaka have also been trained in various capacities bordering on sexual reproductive health.

Kachale sharing notes with CAVWOC Project officer

“We have been able to build capacity of service providers including those working in the public sector. We aimed at building their capacity in provision of comprehensive SRHR services and issues of value clarification attitudes.”

“We have reached out to more than 287 service providers in Lilongwe and Balaka Districts in value clarification attitudes and in the provision of integrated SRH service, we have trained 387 service providers in the two districts,’’ he says.

FPAM’s programs manager, Tazirwa Chipeta, says through the “Her Future, Her Choice’ project, FPAM has so far reached over 45,000 adolescent girls and young women with Sexual and Reproductive Health Rights (SRHR) services in Lilongwe and Balaka districts.

Through Her Future Her Choice Project, adolescent girls, and young women in Balaka and Lilongwe have been empowered to exercise their right to decide whether to be pregnant, the number and spacing of their children and to have pleasurable and safe sexual experiences without the risk of unintended pregnancies. The project has also improved the socioeconomic opportunities for young women and opened more educational opportunities for adolescent girls.

They are only hopeful that the project continues.