As the clock ticks towards the 2030 sustainable development goals timeline, progress in improving access to sexual reproductive health services with a human rights-based approach is moving at a snail’s pace with mixed fortunes for Malawi. However, policy and decision makers are still expressing optimism that the country is on the right track and there are wins to celebrate. Dingaan Mithi writes
According to Edwin Mphando, Oxfam Malawi Country Director, Malawi has made a lot of progress in achieving sexual reproductive health and rights.
He attributes this to strong leadership from many actors, including the government and civil society.
According to latest data from the 2024 demographic health survey (DHS), the country has recorded some decline in maternal mortality (MMR) from 349 per every 100,000 live births to 224. The rate is still too high, activists say, but the progress is notable.
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The United Nations target for 2030 for reducing maternal mortality is set at 70 per 100,000.
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The World Health Organization (WHO) notes that this target is part of a broader effort to improve maternal health outcomes globally. The global MMR was 197 in 2023, which is approximately three times higher than the global target. This means that nearly 700,000 deaths globally need to be prevented between 2024 and 2030 to achieve the target.
Additionally, WHO says that the presence of skilled health personnel at childbirth is crucial for improving maternal and newborn survival.
Chairperson for the Parliamentary Committee on Health, Anthony Masamba, speaking at the launch of CHOICE, a new seven-year project funded by Global Affairs Canada (GAC) asked a probing question to stakeholders.
“Can we really achieve the target to reach 70 in terms of maternal mortality by 2030? This is a food for thought to us all and we need to work harder to hit that target,” he said.
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The health sector strategic plan 2023-2030, which is Malawi’s blue print for the health sector, notes that adolescents constitute 24 percent of the total population and require a wide range of Sexual Reproductive Health Rights (SRHR) services such as attention for unwanted pregnancies and sexually transmitted infections (STIs) including HIV.
According to records, an estimated 31 percent of adolescent females begin childbearing with a high number of complications. Complications from pregnancy and childbirth are among the leading causes of death among girls aged 15- 19 years old, constituting 20 percent of maternal mortality in Malawi, with 14 percent of pregnancies in this age group ending in abortion.
Worse still, teenage pregnancies are also increasing from 29 percent in 2016 to 32 percent in 2025.
In Mzuzu, Jane Murphy, a youth activist expresses concern that many rural and hard to reach areas in Mzimba north have limited availability of sexual reproductive health services for young people.
“Lack of youth friendly health services is contributing to high teenage pregnancy rates. It also shows that many young people are not being reached effectively with reproductive health information, including contraception,” says Murphy, who is chairperson for Mzuzu Youth Action Movement.
Chifundo Gondwe, another youth, agrees with Murphy and points out that stigma and cultural beliefs are some of the key driving factors making young people to shy away from accessing services, even if services are readily available.
“The problem we face as young people is stigma. Often people think that if a young person is going to get contraceptives at a health facility, they are a sex worker. It is very difficult,” she narrates.
According to the United Nations Population Fund (UNFPA) in Malawi, early childbearing, high fertility rates and inadequate access to maternal health services are the main contributing factors in the high number of maternal deaths among young women in Malawi.
Girls aged between 15 and 19 years are twice as likely to die during childbirth as women 20 years and above. Coupled with HIV, complications during pregnancy and childbirth are the leading cause of death for young women aged 15-19 years.
In addition, adolescent fertility rates are high and estimated at 136 per 1000 births.
Unsafe abortion because of unwanted pregnancy is also common among adolescents which is an indicator of girls’ and women’s unmet need for contraception.
In Lilongwe rural, especially in Mitundu, development partners, including Swedish Government, Unicef, UNFPA, WHO, UNAids and the Government of Malawi have been delivering an integrated package of sexual and reproductive health services, HIV sensitive interventions and sexual and gender-based violence prevention. In the district, teenage pregnancies, HIV, sexual and gender-based violence continue to challenging to adolescent sexual reproductive health well.
The 2022-2030 Youth Friendly Health Services strategy shows that adolescents aged 10 – 19 and youth (15 -24) are a vulnerable population, with girls being the most affected due to early, forced and arranged marriages, lower age range (10 -14 years), HIV/Aids, sexual orientation or different gender identities, and disabilities.
“This is aggravated by levels of poverty, long distances to a health service facility, limited access to health services due to unfriendly services for young people, lack of access to quality education, decent employment, and harmful cultural practices,” reads in part of the strategy.
CHOICE, a project led by Oxfam Malawi is one of the projects aimed at increasing the realization of Sexual and Reproductive Health and Rights (SRHR) by those experiencing poverty and marginalization, particularly women, adolescent girls, and persons of diverse sexual orientations, gender identities and expressions and sex characteristics in Malawi.
Deputy Director of Reproductive Health Services in the Ministry of Health, Hans Katengeza, notes that falling rates of maternal and infant mortality are a testimony of concerted efforts by Government and partners such as Oxfam Malawi, National Aids Commission and others in accelerating progress.
“We need to keep the momentum going to reduce maternal deaths and strengthen sexual reproductive health. But we should also not forget that disaster preparedness and climate adaptation and mitigation are critical” explained Katengeza.
