If she were approached six years ago, Ruth Kapwepwe Nkhoma would have treated anyone carrying sexual reproductive health (SRH) messages to her with some good-humoured contempt.
“It did not occur to me that, at some point before I could tie the knot in holy matrimony, I would fall pregnant at the age of 19, just after sitting Malawi School Certificate of Education examinations,” says the 25-year-old mother of one from Malimba in the area of Traditional Authority (T/A) Kalonga in Salima District.
She is referring to 2015, the year she sat MSCE examinations in the district.
However, Kapwepwe Nkhoma can be forgiven for falling pregnant a month after sitting the examinations because, in her own words, “I did not know about sexual reproductive health services”.
It is her perfect excuse but not a foolproof one.
It is true that, in 2015, the National Sexual and Reproductive Health and Rights Policy was not yet ‘born’.
Had it been that the policy was there at the time she was falling pregnant to a man who later denied knowledge of the pregnancy and has never been seen since, she would, probably have come across the following paragraph:
“The need for family planning services arises from the risk of maternal, infant, and child mortality and morbidity when pregnancies are too early, too many, too late, and too frequent. Despite efforts to make family planning services accessible to all Malawians, fertility rate remains high.”
This would, probably, have made her realise that, by falling pregnant at a time she was supposed to proceed to university, she was jumping into a pit countless other teens and women had fallen into before her.
Already, the country has an unsustainably high fertility rate, pitting a growing population against scanty resources.
The Malawi Demographic and Health Survey (MDHS, 2015-16) indicates that Malawi’s fertility rate is at 4.4 per woman, down from the 5.7 percent that is recorded in the MDHS of 2010.
The rate is higher in rural areas, at 4.8 percent, than in urban areas, at 3.0 percent.
However, according to the MDHS, knowledge of sexual reproductive health services and family planning methods is not enough.
“Although knowledge of family planning is high and almost universal at 99 percent, the unmet need for family planning among married women is at 19 percent and total demand for family planning for married people is at 78 percent which is satisfied, whereas demand for family planning for sexually active unmarried people is at 84 percent with only 53 percent of the demand being satisfied,” it indicates.
In 2015, therefore, the odds were stuck against Kapwepwe Nkhoma; more so because “there are 54.2 percent unintended pregnancies among women in Malawi”.
The good news is that the Sexual and Reproductive Health Policy of 2015 addresses such challenges.
Actually, the Malawi Government has no choice but to do the needful because, in line with the recommendations of the International Conference on Population and Development held in Cairo, Egypt, in 1994, it committed to providing “comprehensive and integrated Sexual and Reproductive Health (SRH) services”.
Malawi is also a signatory of the African Union Maputo Plan of Action, which promotes integrated SRH Plan.
The Ministry of Health, through the Reproductive Health Unit, has, since 1997, coordinated the integration, i m p l e m e n t a t i o n , monitoring, and evaluation of SRHR services at all levels, with the Malawi National Reproductive Health Programme serving as the framework through which the ministry manages SRHR services.
This notwithstanding, community members in some parts of the country continue to face challenges when it comes to accessing SRH services.
In some cases, youths, for example, never really know whether their choices are right or wrong. In fact, other youths do not even know whether family planning methods are for them or whether they make any difference anyway.
Jonathan Sambani Mandala, who leads Informed Youth Organisation in Nsanje District, says little has been done to inform youths about their SRH rights.
“One of the problems pertains to the exclusion of youths from consultations during policy-formulation processes. The truth is that youths need contraceptives and other services but feel sidelined because they are often on the receiving end of things,” he says.
In Ntcheu District, however, service providers, traditional and religious leaders seem to have realised that there is nothing for the youth without them [the youth].
Before they came to this conclusion, pregnancy time was a time of family divisions, even of terror, as blame games often ensued.
Today, even traditional leaders such as Group Village Head Sanjani encourage youths to access SRH services to avoid unprepared for pregnancies.
“We are now hearing the youth out. One of the issues that crop up every time we discuss the needs of youths, especially here in the area of T/A Ganya, is that of long distance to health facilities. This is negatively affecting youths’ right to access healthcare service when they need them,” Sanjani says.
He raised the sentiments when, on Tuesday, the Catholic Health Commission (CHC) organised a scorecard meeting at Mwala Oyera Catholic Parish in the area.
“Our nearest health facilities, namely Bwanje and Bilila health centres, are 25 and 30 kilometres, respectively, away from here. This prevents a lot of young people from accessing SRH services and this, in turn, leads to many cases of unplanned for pregnancies and sexually transmitted Infections (STIs),” he says.
Bwanje Health Centre Medical Assistant Sheira Chidyamayani acknowledges the extent of the problem, saying the health facility receives over 40 cases of STIs involving youths on monthly basis.
“Despite providing youth health friendly services at our facility as well as outreach services to surrounding areas, we are registering more cases of STIs,” she said.
CHC Nzatonse Field Officer Harold Chilikutali describes the statistics as “scary”.
“We really need to join hands to address factors that contribute to rising cases of youths that are falling pregnant as well as those that contract STIs,” he says, adding that, through Nzatonse Project being implemented in the district, they hope to put financial resources from Norwegian Church Aid and Danish church Aid— through KFW—to good use to ensure that the problems are put in check.
So far, those aged between 10 and 24 years have been sensitised to sexual reproductive health issues.
The hope is that, over time, unplanned for pregnancies and STIs will no longer loom over youths’ lives, who now avenge on the two enemies by seeking services from health facilities nearby.