No contraceptives in sight

Anne Chafera used to walk over 10 kilometres(km) to access her number one family planning method at Malomo Health Centre in Ntchisi. But lately, she has grown tired of returning home empty-handed.

The long walks and lengthy stock-outs discourage the 23-year-old and her neighbours from using modern family planning methods.
This is happening at a time government and its partners are working hard to ensure sexually active persons use contraceptives to avoid unintended pregnancy.

“With increased awareness, misconceptions in my area are going down and many women are embracing family planning. However, long distances remain a big barrier,” says the mother-of-two, from Kanyendera Village in Traditional Authority (T/A) Chilooko.

The lengthy stock-outs of contraceptives, which span over a month, put off some women who are willing to delay pregnancy and have fewer children.
A visit to some health facilities in Ntchisi in November revealed that the shortage of Depo-Provera and other injectable methods take three months.
This dissuades clients who endure long travels, women say.

Malomo, which serves a population of about 22 000, is among the worst hit.
Chafera personifies the agonies of women struggling to access the contraceptive when they need it most.
To get there, she walks twice the distance the Ministry of Health has proposed for everyone in need of healthcare services.

During the visit, Malomo had run out of Depo-Provera which she uses.
“I have been using the injection for a long time, but I’m not on any contraceptive due to lengthy stock-outs. The health centre ran out of my preferred contraceptive three months ago, putting women at risk of unwanted pregnancy,” she says.

Equally affected is Mary Kamwendo from Kasi Village.
“It is frustrating that government promotes contraceptives, yet it is failing to meet the demand. We travel long distances just to get contraceptives. Imagine travelling about 12 kilometres only to be told there is nothing,” says the 25-year-old.

The jab represents the most widely used family planning in the country.
Noel Ngwata, the medical assistant in charge at Malomo, said he informed Ntchisi District Health Office about the shortage said likely to fuel unwanted pregnancies.

He said: “The facility is facing challenges in providing family planning services due to drug stock-outs and shortage of staff. It has been three months now without contraceptives, yet the demand is high.

“Sometimes we depend on contraceptives from Population Services International [PSI], but we have not received any from them recently. However, we are trying hard to improve the situation.”
The unmet need for family planning is high in rural areas where over eight in 10 Malawians live.

According to the 2015 Malawi and Demographic Health Survey (MDHS), nearly a third of women in the country begin child-bearing before the age of 20 and just about six in every 10 aged 15 to 49 use contraceptives.

In an interview, Ministry of Health and Population spokesperson Joshua Malango said government is working towards making Depo-Provera easily accessible in affected facilities across the country.
He did not state how.

However, family planning empowers women to delay pregnancy and space childbearing. This enhances one’s education, business and employment opportunities.

Most importantly, it helps parents to break the vicious cycle of poverty as they have the number of children they can feed, clothe, educate and care for.

In 2012, Malawi became one of 69 countries that adopted Family Planning 2020 (FP2020) to ensure universal access to contraceptives and address the inequalities faced by communities surrounding Malomo Health Centre.

By 2017, about 1 948 000 women in the country were using modern contraception in a push to avert 555 000 unintended pregnancies, 165 000 unsafe abortions and 2 000 maternal deaths by 2020.

But the MDHS shows that in rural areas, Ensuring that modern contraceptives are available all the time in all the country’s health facilities is key to meeting this lofty commitment to meet 60 percent of the unmet need of all women regardless of who they are, where they live and their economic status.