Monday, February 22, 2010

When accurate reproductive health information lacks

Speaking when she received a K2 million cheque donated to the maternity wing at Chilumba rural hospital by Bottling and Brewing Group Limited (BBGL) on January 27, Vice President and the country’s safe motherhood ambassador Joyce Banda emphasised the need for education in an effort to achieve safe motherhood. In Malawi, sources of education are many. However, there is only one reliable source for such: school. KAREN MSISKA asks, is the system up to the required reproductive health standards?

For all the time she had been rejecting sexual advances from her male acquaintance, Viwongo Manda (not real name) had thought of pregnancy – and nothing else – boggling her mind.

She says that when she was growing up, her grandmother always talked about pregnancy as the consequence of having unprotected sex. She listened soundly.

But once someone convinced and demonstrated to her that not every sexual encounter leads to pregnancy, Viwongo, 17, became a different being. And she has seen the other consequences.

“I wanted to see what it means and I had my first sex about three years ago when I was 14. There was no protection as the one who did it with me said condoms were porous so there was no difference between using condoms and not using them,” said Viwongo recently.

“Of course, I did not get pregnant and I haven’t been pregnant in spite of doing it again a number of times. But I have experienced some things since that first sexual encounter.”

She said, while looking away, that she has had sores and “some bumps” in her private parts and, at some point, she experienced extreme pains when passing out urine.

She added that she never sought treatment during any of these experiences.

Viwongo, who says is in Form III at a non residential secondary school in Mzuzu, could be a tip of a problem that is a collection of misled adolescents.

According to a survey conducted by, among others, Youth Net and Counselling (Yoneco) and published by the Guttmacher Institute in 2007, many adolescent youths have a wide base from which they draw information on sexual and reproductive health.

However, the report – titled ‘Protecting the next generation in Malawi: New evidence on adolescent sexual and reproductive health needs’ – points out that most of these sources of information are inaccurate and grossly unreliable. It identifies, particularly, sexually transmitted infections (STIs) as an element where such inaccurate information exists.

“Although about two out of three Malawian adolescents have heard of STIs other than HIV, much smaller proportions of young people are aware of the symptoms that accompany these infections,” reads the report in part.

“Only one in 10 knew that tenderness in the lower abdomen and itching could indicate an STI.”

The report categorises adolescents as those aged between 12 and 19, and states that most of this inaccurate information is drawn from peers. It says up to 60 percent of the adolescents surveyed said they received sexual and reproductive health information from friends.

It further says adolescent girls are mostly at risk as they are targeted by men who are much older than them. The older men are mostly the ones that infect the young girls with STIs as they might have had other sexual partners before.

On the ground, this translates to an overwhelming number of girls. Results of the 2008 Population and Housing Census conducted by the National Statistical Office (NSO) indicate that there are 844,315 girls aged between 10 and 14 and 651,028 girls aged between 15 and 19 in the country.

Thus, according to the survey, there are 1,495,343 girls aged between 10 and 19 in the country.

Since children aged between 10 and 19 are either in the later stages of primary education, in secondary education or in early years of tertiary education, the question whether their inability to have accurate information on sexual and reproductive health issues is a result of absence of such in schools begs.

The Yoneco reproductive health report acknowledges the availability of sex education in schools. However, it criticises implementation of such education.

It says: “Although sex education is now mandatory in all public schools, implementation remains somewhat problematic.

“For one, the introduction of sex education met with resistance from some teachers. Although their reluctance to teach the subject is said to be waning, facilitated in part by teacher training, some teachers continue to skip some topics because of embarrassment or personal beliefs.”

It says the teachers choose only those topics that they are comfortable to discuss openly and leave out those that would bring them discomfort.

Further, the report says that another barrier to effective sex education is that it is not currently a subject that is tested or graded in the country.

Director of Reproductive Health in the Ministry of Health and Population, Dr Chisale Mhango, agrees and says that if the subject is not examinable students will not pay much attention even when teaching was enhanced.

“We have developed the syllabus for life skills but we do not have nurses who can go to teach it in schools, said Mhango in response to an e-mailed questionnaire late last year.

“The Ministry of Education [Science and Technology] has to teach it otherwise many girls will continue to drop out from school because of pregnancy and, worse still, acquire HIV (Human Immuno-Deficiency Virus).”

A snap check with some students at Msongwe Community Day Secondary School (CDSS) in Mzuzu indicated that the subject has been lined up for examination at Junior Certificate of Education (JCE) level this year.

Ministry of Education Science and Technology spokesperson Lindiwe Chide confirmed that the Malawi National Examinations Board (Maneb) will examine Life Skills at both JCE and Primary School Leaving Certificate (PSLCE) levels this year. Life Skills is a subject that has a sexual and reproductive health component in it.

“Teachers have been sent through some in-service training so that they ably teach the subject. Of course, hiccups have been encountered since the subject was introduced,” said Chide in an interview.

“It’s true that some teachers completely refused to teach the subject the time it was introduced but the situation has improved nowadays since the teachers went through the training.”

The Yoneco report recommends bolstering life skills education at all levels, supporting teacher training so that they impart accurate and comprehensive sexual and reproductive health information and increasing health information reaching the youth.

Whether the situation changes and sexual and reproductive health education is bolstered, one fact will always remain. And this is that, as Vice President Banda put it, education will push efforts to achieve safe motherhood a very long way.

As pan Africanist Marcus Garvey said, an educated community knows what it wants and how to achieve what is wants. But communities made of people like Viwongo would never know what they want and how to achieve them.