There are many things that cause 4,624 Malawian mothers to die during childbirth every year. These are gender inequalities that prevent a woman from going to a hospital early enough to deliver without her uncle’s blessing; unavailability of reliable modes of transport to take her to a hospital equipped with basic emergency obstetric care or a health centre with only a nurse midwife to make 10 deliveries a day.
These causes of maternal deaths are in one way or the other linked to matters of culture, good roads, training of nurses and midwives and even shortage of drugs and medical supplies in our country’s hospitals.
But what it there was a way in which these 13 deaths of mothers per day could be prevented? What if there was a vaccine which mothers could take and avoid by a small margin dying while giving life?
UNFPA reproductive health programme officer Juliana Lunguzi believes if women tried as much as possible to use a family planning method, some of these deaths could be eliminated: family planning is the vaccine, she says.
If more women used contraception, 80,000 abortions could be avoided every year and deaths as a result of abortion related complications would be minimized
If many women decided to take a pill a day, 80 per cent of maternal deaths due to obstetric complications such as bleeding, ruptured uterus, infection, pre-eclampsia would not be a daily occurrence in our country’s hospital.
If this is one of the solutions, why is it family planning usage is only at 41 per cent, 3 per cent of which is use of traditional methods, according to the Multiple Indicator Cluster Survey (2006).
Some of the commonly used methods in Malawi include male and female condoms, pills, depo-provera, Norplant, intra-uterine device or loop, vasectomy or sterilisation, all of which are available at government and private health institutions.
Currently, 100 per cent of Ministry of Health hospitals provide family planning services while it is available in 96 per cent of health centres and 58 per cent in Christian Health Association of Malawi (CHAM) facilities.
Lunguzi says despite this availabaility of services, the contraceptive prevalence rate has been creeping up too slowly due to over reliance on fixed service outlets.
Family planning is just one of the components of reproductive health programmes that government with assistance from various partners is undertaking.
Other components which together can make a woman’s happiest day end happy are prevention and management of sexually transmitted infections and HIV/AIDS, maternal and neo-natal health, management of unsafe abortion and elimination of harmful cultural practices.
Although it’s a long term strategy, family planning is currently being repositioned as the key strategy for achieving Millennium Development Goals of reducing maternal mortality from the current 807 deaths per 100,000 live births to 55 by the year 2015.
“Calculations show that investment of US$37 over the next decade will save Malawi US$76 over and above reducing maternal and child deaths. So it’s something very important all round,” Lunguzi states.
Increased investment in family planning programmes would also cover the 28 per cent of women who would love to use contraceptive but are unable to because of unavailability of their chosen method of contraception.
Increased use of contraceptives, especially among youths, would prevent the 35 per cent of unintended pregnancies among youths, in turn reducing 80,000 abortions which occur annually.
However, the youths are not actively engaged because contraceptive continue to be shrouded under the umbrella of family planning. If you are not married, you have no business seeking a family planning method.
17 year Rhoda Falasi is a Form 1 student at Chitowo CDSS in Dedza should be targeted for family planning methods but she has never been approached.
“I would like to know about family planning methods but I don’t really know of any because I am too young,” she says.
When pressed how she will make sure she doesn’t get pregnant when the time comes, Rhoda says maybe when gets married, the community based distribution agents (CBDAs) in her village will come to her.
She is however aware that some youths in her village inform others on using condoms during sex but she is yet again yet to be approached by her own peers.
Rhoda lives in Chitowo (population 29,404) in Dedza, an area that has garnered acclaim for reversing incidences of maternal deaths from 24 per year in 2001 to zero in 2009.
This was made possible by promoting community involvement in reproductive health through training of village health committees, setting up CBDAs and establishing community safe motherhood task forces.
The taskforce is given the responsibility of following up a pregnancy outcomes, examining and recording maternal deaths in their areas, according to Chitowo chairman of the taskforce, group village headman Dzoole.
The taskforce encourages the mother to deliver at a health centre and failure to do so, by-laws are enforced through fines of K1,000 or a goat.
But it is the role of CBDAs that is very crucial in Chitowo, as Mary Nyondo explains. She is mandated with distributing two contraceptive methods, condoms and pills.
Previously viewed as taboo (zolawula), Nyondo says most people in the area have done away with traditional methods and receive her more warmly when she visits them.
“I go door to door visiting my clients and counseling them on the methods they can use. When they select a method, I give them and inform them when I will visit them again,” she says.
But does she realize the importance of her work?
“Of course,” she says, “during training, we were told that if women in our areas do not give birth frequently, they will not die during child birth so we are doing our part in this work.”
Although she doesn’t distribute female condoms, Nyondo says some women have expressed interest after hearing about them on the radio. She hopes soon she will be able to distribute them alongside male condoms.
But when her clients choose the injection (or depo provera) or sterilization, she is trained to refer them to a hospital and she gives them a referral letter.
For now, she only counsels and approaches married women although this is not by choice.
“Some girls have approached me but only to tell me they fear their parents finding out they are using family planning. I have seen girls dying from child births and some died not knowing it could be prevented,” she says.
In her work, Nyondo travels on foot in the villages of Mphunda, Chitimbe, Chintiyande and Mkhanga logging in women she has helped and she should visit them again.
The fact that no woman has died from child birth related complications is enough reason for her to carry on.
A male CBDA Zebron Moyo is one of five members says secrecy is very important in the work they do which is why he only visits couples when they are together.
He works in six villages: Magwaza, Kauma, Chintokoma, Chagwiranyama, Nabwenje and Mtembe delivering condoms and pills with the hope of reducing maternal deaths.
Moyo is father of six children, three of whom are boys one of whom is married. His son finished stopped school in Form 1 and went on get married, which he says he regrets not stopping him now.
His daughters are still in school, one is in Standard 7, another is Standard 5 and the last one in Standard 4.
When asked whether he would be free to approach youths in his area about family planning methods, Moyo says the youths have other activities which keep them occupied such as playing bawo or dancing chitelera and sharing ideas HIV prevention messages.
He would however want to inform his own daughters of his work and its importance to their life but cultural traditions do not allow him to do so.
It’s accepting his young daughters will need to know about contraceptives that he has a problem with however important it might be.
If only he knew that he was administering a vaccine, perhaps he would sit his daughters down and tell them the hard facts of maternal deaths and its impact on the family, community and nation as whole.
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