To a better future with family planning

Picture a situation where a secondary school girl is impregnated. The result is dismissal as Malawian schools do not condone pregnancies. And this marks the beginning of problems for her. Interjections from fellow pupils; sarcastic jabbering and disturbance from education are just some of them.

According to research conducted by, among others, Youth Net and Counselling (Yoneco) and published in 2007 by the Guttmacher Institute, “early marriage and child bearing may isolate young women by leading to school attrition and reduced independence.”

The paper, titled ‘Protecting the Next Generation in Malawi: New Evidence on Adolescent Sexual and Reproductive Health Needs’, says 11 percent of the girls and young women aged 15-19, and interviewed during the research, said they “discontinued schooling because of pregnancy.”

Getting pregnant while in school highlights how unexpectedly pregnancy comes — pregnancy is often unintended or unplanned. It also points to how unaware partners are as regards sexuality and pregnancy issues. Pregnancy is testimony of unprotected sex. And pregnancy leads to birth.

Women the world over die while giving birth. Many others die from complications related to the pregnancy, thus adding to woes which a secondary school girl who falls pregnant while there would face.

In Malawi, recent statistics indicate that up to 807 women in every 100,000 die while giving birth. Many others suffer complications as others die. The United Nations Population Fund (UNFPA) says the world over, “for every woman that dies due to pregnancy complications, 20 or more are injured or disabled.”

And for Malawi, the situation is more than scaring. With a fertility rate of up to 6.3, chances are that girls and women are destined for death and injury. Survival is rare. One may be trapped at any one of the average six pregnancies.

According to the Family Planning Association of Malawi (FPAM), 30 percent of all maternal deaths are due to abortion. Such abortions are undoubtedly aided and abetted by the Malawian law which does not condone any form of abortion — safe or unsafe, medically necessary or not. And because hospitals will not go against the law, those who fall pregnant but do not want it choose this perilous route.

It is hard to get a confession from those that have ever aborted. Who doesn’t fear the law? As such stories of how abortion is conducted may only come from the grapevine. Some say those who do it overdose themselves with drugs or drink soapy solutions. Others say they force sharp objects through their vagina resulting to injury. Yet others say such people take equally deadly concoctions which they get from mostly herbalists.

“It’s two things if one aborts. Either she dies or she gets permanent damage to the reproductive system. When permanent damage occurs, the affected person never gives birth again,” says Lawrent Kumchenga, FPAM Information Education and Communications, Advocacy and Public Relations Officer.

“As such, the solution to an unwanted pregnancy, thus an end to such deaths and injuries, is family planning. Pregnancy is avoided when a family planning method is used. And when pregnancy is avoided, one cannot think about abortion. Therefore, there is no death and injury because of abortion and society would remain progressive.”

The World Health Organisation (WHO) reckons family planning as an initiative through which couples can “anticipate and attain their desired number of children and the spacing and timing of their births.” It further reckons that family planning has a direct bearing on a woman’s health.

UNFPA says reduced child bearing prevents injuries in the birth canal. One such injury is obstetric fistula, a hole in the vagina or rectum often caused by prolonged labour without treatment.

“It leaves women in social isolation, depression and deepening poverty as it leaves them leaking urine or faeces or both,” it says.

Family planning methods like condom use also save women from cancer of the cervix, the deadliest of cancers affecting women. The Centre for Reproductive Health (CRH) at the Malawi College of Medicine says the human papillomavirus (HPV) which causes the disease is transmitted during unprotected penetrative sex.

CRH Director Dr Frank Taulo says protecting women from the disease would create a better future as death of a woman mirrors a troubled and compromised future.

“The entire family is affected and the impact is far reaching,” he says.

Besides, family planning accords the mother’s body adequate time to regain strength after the pregnancy, according to Malawi Health Equity Network (MHEN) Country Coordinator Martha Kwataine.

“Additionally, for those who deliver through caesarean sections, the uterus requires at least two full years of break before it can accommodate another foetus,” she says.

Benefits of family planning go beyond those on women’s health. Kumchenga says employing methods of birth control for periods of financial struggle, while setting money aside for unseen hardships (infertility, illness and loss of income) during times of prosperity, will help avoid financial anxiety an unplanned pregnancy may bring.

He adds that besides enhanced family time management as result of fewer children to look after, family planning leads to attainment of higher education because “there is less stress, worry and guilt”. Higher education contributes greatly to a country’s productivity. Earth’s resources also last longer with fewer people, a direct result of family planning.

Kwataine says family planning also takes away the depression older children suffer because mothers abandon them and focus on looking after the newborns. She says such depression leads to loss of appetite which results into malnutrition in these children.

“Family planning can help to break the vicious cycle of poverty. Having a relatively small number of children economically empowers the family to ably provide for the needs of the children such as high quality education, food and clothing, among others,” adds Kwataine.

“Well cared for children tend to excel in life and contribute to economic development. Thus, family planning is a key to reducing poverty both nationally and at household level. Family planning is also a tool to controlling population growth hence protection of the environment.”

Seven family planning methods are available for use in Malawi. They include pills, condoms, Depo Provera, Norplant, loop, Tubal ligation and vasectomy. Tubal ligation is a permanent method for women while vasectomy is a permanent initiative for men.

“The mostly used in Malawi is Depor Provera,” says Kumchenga. “Women do not need to go to the hospital often. It is done once in three months. It is cheaper, not many women complain about side effects, it is readily available and can be administered by nurses unlike others which require more skilled personnel.”

Unfortunately, only 41 percent of women in Malawi use a family planning method. This could be a result of “poverty and profound inequalities between men and women limiting women’s ability to plan their pregnancies.” UNFPA notes these as women’s major barriers to access contraceptives in many countries. Culture and religion could be other reasons.

This calls for action. The action is to propagate benefits of family planning. Let there be male involvement. What culture and religion hold on family planning should be revisited just as was the case with HIV and Aids. There is need for civic education. And when advocacy starts, there should be no relenting.