LILONGWE—People are free to decide on the size of their family and it can be argued that a family with a few children is better able to provide for everyone’s needs. The Mathews family of Mchinji in central Malawi knows that first hand.
Akilewo Mathews was 25 when he fell in love with a 17-year-old girl. They didn’t waste time and got married right away. He’d dropped out of school after successfully passing his secondary school Junior Certificate in 1995 because he didn’t have school fees.
The logical next step was to be productive member of society but he had to get married first as his community – and Malawi society at large – view a family person more favourably than one who is single. Within a year of getting married, the couple was blessed with a gift of a baby girl in 1996. They had two more in 1997 and 1998.
Another child was on the way in 1999 but this time something had changed. It was the mother’s health and it affected the whole family. “It was becoming difficult for my wife to look after the children,” recalls Akilewo.
“I had to attend to them while at the same time I was supposed to get her to the health centre for either medical checkup or treatment.” More attention paid to the caring of his wife and children meant insufficient attention to farming and they harvested little. In the year 2000, Akilewo first paid serious attention to the health messages that were brought to the village by Health Surveillance Assistances (HSA) who had embarked on reproductive health and family planning sensitization campaigns that saw them crisscrossing T/A Mavwere’s area through door to door awareness raising meetings.
“I had heard these messages on the radio but [paid no attention] because it was then widely believed that the family planning methods that were being promoted diminishes a couple’s urge for sex,” he recalls, adding that as villagers they were fed with wrong information to the effect that the methods were responsible for family infertility. “But after listening to the counsel by the HSAs I saw the link between poverty and unplanned pregnancies,” he narrates. “I am a living example of someone whose family has suffered because of lack of family planning.”
Akilewo says from that moment his family decided to use the pill to prevent unwanted pregnancies. “Our next child after that decision came in 2005.” He says their lives have improved and there’s been improved productivity on his farm. When his wife was sick, he could only harvest about five bangs of maize. “Currently, I harvest over 60 bags of maize on my same one and a half acre land where I also do small scale tobacco farming.”
Realizing the benefits of family planning, in 2002 Akilowe joined a group of volunteers to spread the message in his Guwede village, which leads in providing outstanding access to reproductive health services. In the past five years, there’s been no maternal death in the village.
Akilewo says the volunteers provide basic reproductive health services to willing families while they refer cases opting for advanced services to Nkhwazi Health Centre for more professional medical assistance. As a result of the initiative, contraceptive prevalence rate has improved from 13 per cent in 1998 to 28 per cent in 2004 before leaping to 42 per cent in 2010.
“The effect has been a corresponding decline in total fertility rate from 7.3 per cent in the early eighties to 5.7 per cent in 2010,” says UNFPA country representative Antanase Nzokirishaka. “This is a clear demonstration how community based programmes planned together with communities themselves can become sustainable.”
The effort has earned the country international recognition leading to the attainment of the 2011 Kenya Regional Family Planning Conference Community based Initiative award and the 2012 Global Leaders Council for Reproductive Health award. Malawi Minister of Development Planning and Cooperation Atupele Muluzi says access to family planning and reproductive health services are essential for the development of any nation.
He says poverty among women, their lack of power over to choose desired family planning methods, cultural practices, long distances to health facilities and inadequate health personnel are some of the issue that have triggered high maternal mortality rates in Malawi. According to the 2008 Population and Housing Census conducted by the National Statistical Office (NSO), the total fertility rate among married women was six children; five for widows; five for divorced or separated women and two for women who had never married.
The NSO observed that the differences in fertility were mainly due to different socio-economic characteristics of women including literacy and area of residence. “The death of women not only affects their families but the whole community since they are one of the leading causes of orphanhood,” says Muluzi who explains that government was addressing the challenges by sensitizing the population on family planning and reproductive health, promoting women economic empowerment programmes as well as increasing enrolment in health schools and recruitment in health facilities.
Nevertheless, Nzokirishaka points out the need to re-energise the commitment of stakeholders, especially local people themselves to realize universal access to reproductive health services. He says in Malawi 26 out every 100 sexually active women who want to delay or avoid pregnancy have no access to modern contraceptives.
“Achieving universal reproductive health services will not take full effect if we do not address the special needs of young people, particularly adolescent girls,” he points out. Early pregnancies and childbearing complications are some of the major causes of death among girls 10-19 years of age while the highest rates of sexually transmitted infections are among those between the ages of 15 and 24.
“It is my strong belief that only when women and youths are empowered to freely choose the number and when to have children will poverty and socio-economic inequalities be fully addressed,” emphasizes Nzokirishaka. During the 2012 London Family Planning Summit, Malawi’s Vice President Khumbo Kachale made a commitment to have the National Population Policy approved by the end of the years. He said Malawi would include family planning in its budget and hoped to raise the contraceptive prevalence rate to 60 per cent by 2020 with special focus on the youth.