Helping couples make informed choices

If it were not for women like Asimenye Mwafulirwa, women and men of Mvera Support Battalion and surrounding villages in T/A Chiwere in Salima would not have made informed choices to put their children’s livelihoods and own lives first.

Mwafulirwa has been working as a Community Based Distribution Agent (CBDA) since 2008 and she has met with hostile couples who believe that modern family methods are too dangerous.

“I have been chased from people’s houses like a dog but I keep on visiting them until they understand what I am telling them and decide for themselves how they will use the information,” says the brave young woman.

Trained by Family Planning Association of Malawi (FPAM) in 2008, Mwafulirwa is a distributor of contraceptives door to door in Salima. She is one of 15 men and women who on a weekly basis visit couples in their areas of work informing them about family planning methods and how adopting them could change their lives.

They work in a catchment area of 5,630 people, each CBDA looks after the inhabitants of two villages, being there for them when they need help and visiting them frequently.

With a client list of over 200, Mwafulirwa is a hub of knowledge on sexually transmitted infections, HIV and AIDS and contraceptives.

Contrary to popular belief, Mwafulirwa says she does tell her clients about the advantages and disadvantages of using modern family planning methods.

While protesting the use of modern methods, the people in GVH Chiwere’s area argue that traditional methods of swallowing Mzama (pigeon peas) and tying Mkuzi have worked for them for many centuries.

Mwafulirwa says she has failed to get an understanding of how Mzama or Mkuzi works and her long client list can attest that people’s mindsets are changing.

One of Mwafulirwa’s clients is Donna Simfukwe (Mrs Mwangonde), 32, who as a Christian believes that mankind should be fruitful and multiply. As soon as she and her soldier husband married, she had five children in quick succession.

Her children are now aged 12, 11, 9, 8 and three. So how does she explain the gap between the fourth and last born?

“My husband and I didn’t believe in stopping the natural occurrence of having children. We believe in the bible and it doesn’t stop people from having as many children as they can. So we had five, four of them born one after the other,” she says.

While her friends joined community based organizations or became caregivers for the chronically ill, she was busy looking after her children or expectant with another child.

When a CBDA approached the couple, the Mwangondes realized how giving birth too quickly was affecting their life.

Since she started using the pill, her last child was born in 2007 and she has since joined a home based care group as a volunteer.

“We were buying nappies every year. To find soap, clothes and food for the children was not easy. Each year I would have only one chitenje for the baby. My children were always malnourished because I would stop breastfeeding when I became pregnant,” she says.

UNFPA reproductive health officer Juliana Lunguzi has touted family planning as the vaccine for preventing maternal mortality.

With the use of family planning, maternal deaths could go down from the current 807 per 100,000 live births, Under 5 mortality could reduce from even further from 100 per 1,000 live births to at least 72, as per Malawi’s MDG targets and the number of abortions which take place per year could go down from 80,000.

It has become so important that it is being repositioned as the catalyst for achieving the Millennium Developmen Goals (MDGs) 5 and 6 on reducing incidences of maternal and child mortality.

Being one of the policy themes of the reproductive health programme of the Ministry of Health and its partners, Lunguzi says there is need to increase the contraceptive prevalence rate from the current 41 per cent (including 3 per cent traditional methods) and cover the unmet need of 28 per cent.

The family planning method of pills and injectable, popularly known as Depo Provera, are the most popular in GVH CHiwere but unfortunately CBDAs like Mwafulirwa are not allowed to administer injectables.

This problem has been solved however as FPAM holds an outreach clinic at the Mvera Support Battalion where couples who have made choices such as injectables or vasectomy can be assisted, according to FPAM programme officer Bessie Nkhwazi.

In its outreach clinics, FPAM restocks family planning commodities, provides regular and emergency contraception, pregnancy tests and conducts voluntary counseling and testing for HIV.

Village Headman Mdoola says the Chiwere area has a population of close to 400 households but farming land is not enough.

The most popular crops grown are maize, groundnuts, tobacco and soya but every year, people continue to harvest less and less, especially the cash crops.

The village headman says in the last growing season some villages got less than 15 coupons to buy subsidized fertilizer and seed at K500 when more and more farmers could not afford inputs.

“We will have enough this year but if the population continues to grow, some families will start moving from here and settle somewhere else. Maybe along the lake,” he says.

He says when CBDAs started working in the villages, they were not taken seriously when told that the benefits of using family planning methods included fewer maternal deaths, healthy children and enough food.

“I now believe it. It was difficult at first to link how the issues were related because most of us believe in the traditional ways. We now have health personnel coming here and more and more people are attending the clinics,” he says.