She rolled down in pain on the light brown locally made mat. She has had the labour pains for three days now but there is no progress.
Surprisingly, her mother, together with female elders of Kawinga area in Machinga are of the view that it is not yet time to go to a health centre; despite the pain that 14 year old Everesi Makaiko is going through.
Makaiko is later taken to Ntaja Health Centre, from where she is referred to Machinga district hospital. Her birth canal is too small for the baby to pass through, so an episiotomy is a must.
World Health Organisation describes episiotomy as the surgical incision of the perineum and the posterior vaginal wall, generally done by a midwife or obstetrician during second stage of labor to quickly enlarge the opening for the baby to pass through.
“Unfortunately, this pain, episiotomy and the injury were in vain. The baby was a still born. From that time on, I leaked urine all the time. The pregnancy aftermath was a source of discomfort and discrimination. Nobody wanted to associate with me. I produced lots of smell,” she recalls.
Makaiko developed obstetic Fistula due to probable prolonged labour. United Nations Population Fund (UNFPA) says Fistula is one of the most serious and tragic childbirth injuries. It is a hole between the birth canal and bladder or rectum caused by prolonged, obstructed labour, without access to timely and high quality medical treatment. It leaves women leaking urine, feaces, or both and often leads to chronic medical problems, depression, social isolation and deepening poverty.
Makaiko narrates that she was in standard five when her 18 year old (school dropout) boyfriend impregnated her.Their parents were not even bothered that she was pregnant while in school,they instead facilitated their marriage.
“My boyfriend had nothing to prove that he could take care of me and the baby, but this was not an issue.Our parents were just excited that we should get married. They gave us a house to be living in,” she says.
Makaiko admits that even though they loved each other, they lived in extreme poverty. Both of them were young and could not do any income generating activity.
After she went through the painful delivery experience and developed fistula, Makaiko’s life completely changed. She was highly discriminated by friends and relatives.
“My parents later chased my husband away. They claimed he was lazy and couldn’t do work in the farm or build a house for us. This was sadly the time I was in this embarrassing ‘urine leaking’ situation. It took away my pride as a person and woman,” laments the now 32 year old Makaiko, who used to change pieces of blankets not less than ten times a day to absorb the urine.
Throughout the five years she had the Fistula, her parents moved from one native doctor to the other. They drained all the money they had made after selling their farm produce, through paying native doctor ‘bills’. This also affected their household; they did not have enough resources to keep them going.
“But nothing changed. Relationships were affected, as every herbalist we visited told us that some relation(s) had bewitched me. I never used to walk;I used bigger blanket pieces for comfort. I had blisters all over my inner thighs. My life was hell,” Makaiko says.
In her lonely state, she listened to the radio a lot. One day, she heard that her condition is curable and that women who have it should report to any medical institution for assistance. She went through all the reference stages and her fistula was finally repaired at Zomba Central Hospital.
Since then, Makaiko has strongly detested teen pregnancies. She has become an advocate, encouraging girls to stay in school. She has used her personal experience to explain how bad teen pregnancies are and the consequences of dropping out of school.
“While in hospital that time, I saw a lot. I saw teenagers dying of pregnancy related complications, while others came back with injuries, just like me. Some of them could not even walk properly. Teen pregnancies are terrible,” Makaiko admits.
But in this area of Paramount Chief Kawinga in Machinga district, teen pregnancies seem to be the older of the day.
Paramount Chief Kawinga himself admits that teen pregnancies are a big challenge in his area because the girls do not understand the importance of education.
“They can’t wait to have sex. They behave as if they are in a competition. If they see a friend pregnant, they admire that and want to have it too,” he says, adding that even child marriages (like that of Makaiko) are short lived as most of them usually end up in divorce.
Just like what Makaiko went through, Kawinga observes that most child marriages are shaky because of poverty.
“The couple literally has nothing including own blanket,” he said.
He then reveals that the area has a task force, which was established with the help of Nayuchi AIDS Network Services (Nanes), in order to deal with the problem by punishing parents, the pregnant girl and the boy who impregnates her, using by-laws.
“The primary message to the youth is that they should abstain because it’s not their time yet. But if they can’t, they should be using a condom,” he says.
Headmaster for Mlirankhandwe primary school, Boniface Padoko, says 17 pupils dropped out of school due to pregnancies in the 2015/2016 school year.
“When such girls are re-admitted into school, they take long to finish their studies and the chances of completion are very slim. Most parents are not interested to let them get back in school,” he says.
Medical Technician and Youth Friendly Health Services (YFHS) Coordinator for Kawinga Health Centre, Francis Nthonga, observes that there is no marriage control in the area, a thing which leads to child marriages, polygamy and early sex debut.
“One man can have many wives and these other wives usually happen to be teenagers. Many youths of this area also like to go to South Africa for greener pastures. They make a lot of money, which gives them the power to have many wives. They feel they can afford their material needs,” he observes.
Nthonga reveals that 75 percent of the women attending antenatal clinics at the facility are teenagers. He, however, says the taskforce in which Paramount Chief Kawinga has been involved in, has at least helped in reducing teen pregnancies in primary schools.
“The main focus for the taskforce and other Non Governmental Organisations seem to be primary school pupils and not those in secondary schools. There has been no follow up information for the girls that were saved from teen pregnancies at primary school, as a result, there are high pregnancies among girls who are in secondary school,” he says, adding that Saint Mary’s Community Day Secondary School alone recorded 29 pregnancies in the 2015/2016 school year.
Nthonga says youths of the area are now able to access contraceptives, condoms and Sexual Reproductive Health (SRH) information from the health centre’s YFHS at anytime.
UNFPA says child marriage, coupled with school drop outs for girls are of big concern to Malawi. It says about 47 percent of girls marry before their 18th birthday and 25 percent of girls never finish primary school due to child marriage.
UNFPA notes that Malawi is one of the Sub Saharan countries whose youths still have problems to access sexual reproductive health services information and services, hence the unwanted teen pregnancies.
Executive Director of Nanes Chifunilo Moir says the organisation is working in Paramount Kawinga’s area after their survey established that there were a lot of teenage pregnancies and school drop outs in the area.
“We noticed that SRH issues were a taboo here, so we decided to reach out to influential leaders to facilitate the establishment of the taskforce which came up with by laws to penalize any parent whose daughter has been impregnated or any parent whose son has impregnated a girl. This taskforce encourages the youth to be accessing contraceptives, should they fail to abstain from sex,” he says.
Malawi Demographic and Health Survey (MDHS) of 2016 shows that teenage (15-19) pregnancies have increased in Malawi, from 26 percent in 2010 to 29 percent now.
It further says 31 percent of women in rural areas (just like Everesi Makaiko) have begun child bearing in their teenage years as compared to 21 percent of their urban counterparts.
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