‘Children by choice, not by chance’

Since its genesis in 1987, Banja La Mtsogolo (BLM), the local arm of Marie Stoppes International, has opened 29 clinics to ensure every child is born by choice and not by chance. In this interview, our Features Editor JAMES CHAVULA catches up with BLM country director Maarten Van de Reep to discuss the country’s push to increase uptake of modern family planning methods.

After the 30th anniversary, what new challenges lies ahead?

There has been a tremendous growth in the past 30 years and the opening of the new clinic in Blantyre testifies to this. Looking forward, BLM will continue to work in partnership with both government and donor partners to provide reproductive health services to the entire country to the best of our ability. You can expect us to come up with new ways of serving our clients, reaching out to the youth and expending choices of women of 25 and above who constitute the majority of our clients. The challenge is how to bring the age of contraceptive use down so that girls can access sexual and reproductive health services, including contraceptives, to postpone or delay the first pregnancy. This will allow them to remain in school and achieve their potential.

What measures has BLM put in place to reach the youth better?

Firstly, our dedicated team is working hard to ensure the youth can access vital services. We make sure that our service providers are not judgemental. We want to everyone in our clinic, whether married or not.  We do not want anyone to feel out of place.  Our clinics provide services that are not judgemental for everyone.

What is your view on the rising call for the country to relax penal laws which only allow a woman to terminate a pregnancy when her life is in danger?

The country will not achieve its goal to reduce marternal mortality unless it addresses the issue of unsafe abortion. We feel that the proposed Termination of Pregnancy Act is a step in the right way to ensure unsafe abortion is reduced.

As an institution at the receiving end of of post-abort complications, what do you make of the speed at which the country is handling the law reform?

The country moves at its own pace. It is not for me to say whether it is fast enough or not. Some of the proposed changes are controversial and we should debate about it. This is how it should be. This is an issue that affects society and there are different viewpoints on what should be done in terms of the changing of the law. I think we need an honest debate. It is a good thing that Malawi is taking its time to debate the issue and to understand the issue before making the big decisions. I would encourage each and everyone to make sure that you understand what the burning issues are before you make up your mind and take a position on it.

On which side is BLM?

Here at BLM we are on the side of service delivery. We experience some of the negative effects of unsafe abortion on a daily basis which has shaped our view in this debate.

What are those experiences you are talking about?

Unsafe abortion is a major cause of maternal death. The fact that women are not able to access safe abortion often results in desperation that compels them to seek services that are not safe and quality assured. This leads to all manner of complications which affect their health. The fact that abortion services are not available in a safe and legal manner unfortunately does not stop from finding risky services when they are in a position where they think they are in need.

The burden of unintended pregnancies, including teen pregnancies, is still high in the country. How is the cost of treating unsafe abortion impacting your resources?

I don’t think it is draining our resources.  We are first and foremost a service provider. So, we provide these services to the best of our ability and within the compacts and legal frameworks acceptable in Malawi.

We would like to improve the way we provide reproductive health services to young people. But it is challenging, it is difficult. There are so many societal norms, myths and barriers that make it difficult for young people to access reproductive services. We try our best to dispel some of those myths. We tell them what family planning is all about, its importance and whether it is good for them or not.  We try to engage with young people and youth leaders, government and our partners on such issues from a service provider perspective. We get to experience the problems that young people face on day-to-day basis in terms of sexual and reproductive health.

A perception is widespread that BLM offers abortion, does it?

We offer post-abortion care which is distinctly different. We operate within the legal restraints that Malawi has.

What will it take for Malawi to achieve reliable and universal access to contraceptive as spelled out in the Maputo Protocol which government ratified?

Ratifying an agreement and making it a reality are two different things. It is commendable that Malawi government recognised that reproductive health services, including contraceptives, should be accessible to all. The challenge is how you make that a reality. I believe that this government is committed to make it happen. We are working in close partnership with the Ministry of Health, we have done so in the past 30 years and we will continue doing so going forward.

How do you feel that a country which endorsed the push for universal access to contraceptives has a policy that bans sexually active learners from accessing contraceptives in school?

There are challenges. Of course, there will always be challenges.  One of them is the policy which bans contraceptives within school premises. That’s a limitation indeed. It means any service provider has to put these services outside the school. Ideally, it would be better to create an environment where service providers can bring these services to sexually active young people as closer as possible.  But it is not for BLM to dictate policy. That’s for policymakers.

Much as the country has made strides to increase the uptake of contraceptives. What will it take to reach women who want to postpone or delay pregnancy, but cannot access any modern family planning method?

The unmet demands remain big. The gaps is 19 percent, but urban populations are well covered by BLM and other service providers. The gap is huge in rural areas. At BLM, we conduct outreach clinics to reduce the unmet need, but the gap is really how to reach young people and hard-to-reach areas.  Reaching them will require expansion of services that BLM and other partners provide. Obviously, this calls for greater funding. There is need for more resources.