Building healthy families through community based family planning

Community health workers in Africa

Lilongwe – Akilewo Mathews had not had very happy moments since the last two years. Fatigue, anxiety and uncertainty clouded his mind and had roughed up his face as well as weighed down his body since the birth of his third and forth children. His wife too was going through physical and emotional turmoil almost every other day pulled by the demanding tenor of her life which she failed to cope up with. The passage of the four years of their marriage and birth of the four children in their family had fanned away the flames of their energies to sink into a puddle of grey ash. Born in 1970 in Guwede village, Traditional Authority Mavwere, in Malawi’s central region district of Mchinji whose footstool is agriculture, Akilewo had grown up an energetic and remarkable young man. He dropped out of school after successfully passing his Secondary school Junior Certificate in 1995, due to a twin of reasons; lack of school fees as well as fear of being left on the shelf in a community where a man’s worth was much defined by his marital status.

The 25 year old had caught the love of a seventeen year old young woman whom he did not waste time to marry. They had a traditional wedding ceremony in the same year and were blessed with a gift of a baby girl in 1996. In 1997 they had their second child who was followed by yet another in 1998. By the time Akilewo’s wife conceived the fourth child in 1999, the flesh around her body had begun to thicken, blur and turn floppy. Her health too began to sap and waste away. Her condition slowly became a cause for Akilewo’s concern. It was affecting the raising of the children as much as it affected his one and half acre land farming routine. “It was becoming difficult for my wife to look after the children,” recalls Akilewo. “I had to attend to them while at the same time I was supposed to get her to the health centre for either medical check up or treatment.” Akilewo soon realized that the situation was getting out of hand when he noted that the yield from his farm land where he grew maize, the staple diet, declined to four or five bags a year. “I knew all this was because both me and my wife were putting little effort in farming because of her persistent ill health,” he says.

In the year 2000, Akilewo first paid serious attention to the health messages that were brought to the village by Health Surveillance Assistances (HSA) who had embarked on reproductive health and family planning sensitization campaigns that saw them crisscrossing T/A Mavwere’s area through door to door awareness raising meetings. “Initially I had heard these messages on the radio but had not taken heed of them because it was then widely believed that the family planning methods that were being promoted diminishes a couple’s urge for sex,” he remembers adding that as villagers they were fed with wrong information to the effect that the methods were responsible for family infertility. “But after listening to the counsel by the HSAs I saw the link between poverty and unplanned pregnancies,” he narrates. “I am a living example of someone whose family has suffered because of lack of family planning.” Akilewo says from that moment his family took a decision to use the pill in order to prevent further unwanted pregnancies. “Our next child after that decision came in 2005,” he says explaining how the decision improved the health of the whole family as well as increased labour productivity. “Currently, I harvest over 60 bags of maize on my same one and a half acre land where I also do small scale tobacco farming.” Realizing the benefits of family planning, in 2002 Akilowe joined a group of volunteers to spread the message across and beyond Guwede village.

Today, Guwede village is an outstanding community in access to reproductive health services so much that in the past five years there has been no maternal death in the village. UNFPA country representative Antanase Nzokirishaka says the situation in Guwede village is enough testimony that communities, led by their chiefs, can empower the local people to realize universal access to reproductive health services thereby resulting in health families and reduced maternal deaths. “This is a clear demonstration how community based programmes planned together with communities themselves can become sustainable,” he observes. Akilewo says the volunteers provide basic reproductive health services to willing families while they refer cases opting for advanced services to Nkhwazi Health centre for more professional medical assistance. Nzokirishaka commends the Ministry of Health for the task shifting efforts in taking reproductive health and family planning services from static secondary and tertially health centres to the communities through community based distribution agents such as Akilewo, a move which he says has promoted universal access by getting the services to the people.

As a result of the initiative, contraceptive prevalence rate has improved from 13 per cent in 1998 to 28 per cent in 2004 before leaping to 42 per cent in 2010. “The effect has been a corresponding decline in total fertility rate from 7.3 per cent in the early eighties to 5.7 per cent in 2010,” says the UN diplomat. The effort has earned the country international recognition leading to the attainment of the 2011 Kenya Regional Family Planning Conference Community based Initiative award and the 2012 Global Leaders Council for Reproductive Health award. Meanwhile, Akilewo has since 2005 been using the loop, a method that prevents a woman from getting pregnant for five years. “Actually with five children we intend to continue using the method,” he proudly says. Malawi Minister of Development Planning and Cooperation Atupele Muluzi say access to family planning and reproductive health services are essential for the development of any nation. He says poverty among women, their lack of power over to choose desired family planning methods, cultural practices, long distances to health facilities and inadequate health personnel are some of the issue that have triggered high maternal mortality rates in Malawi. According to the 2008 Population and Housing Census conducted by the National Statistical Office (NSO), the total fertility rate among married women hanged at 6 children while it swayed around 5 for widows, 5 for divorced or separated women and two for women who had never married.

The NSO observed that the differences in fertility were mainly due to different socio-economic characteristics of women including literacy, area of residence and other background characteristics. “The death of women not only affects their families but the whole community since they are one of the leading causes of orphanhood,” says Muluzi who explains that government was addressing the challenges by sensitizing the population on family planning and reproductive health, promoting women economic empowerment programmes as well as increasing the enrolment and recruitment health workers in medical schools and health facilities respectively. Nevertheless, Nzokirishaka notes that more individuals and families in the country that would have wanted to use family planning methods were yet to realize their want. He points out the need to re-energise the commitment of stakeholders, especially local people themselves to realize universal access to reproductive health services. He says in Malawi 26 out every 100 sexually active women who want to delay or avoid pregnancy have no access to modern contraceptives. “Achieving universal reproductive health services will not take full effect if we do not address the special needs of young people, particularly adolescent girls,” he points out.

Early pregnancies and childbearing complications are some of the major causes of death among girl between the ages on 10 and 19 years old while the highest rates of sexually transmitted infections are among young people aged 15 to 24. “It is my strong belief that only when women and youths are empowered to freely choose the number and when to have children will poverty and socio-economic inequalities be fully addressed,” emphasizes Nzokirishaka. During the 2012 London Family Planning Summit, the Malawi vice president Khumbo Kachale made a commitment to have the National Population Policy approved by the end of the years. He said Malawi would ensure that there is a budget line on family planning and hinted at raising the contraceptive prevalence rate to 60 per cent by 2020 with special focus on the youth.

© 2012, Charles Mkula. All rights reserved. – The views expressed here are purely those of the author and not necessarily those of the publishers. – Newstime Africa content cannot be reproduced in any form – electronic or print – without prior consent of the Publishers. Copyright infringement will be pursued and perpetrators prosecuted.

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