A man carrying a reed mat leads the way as grief-stricken villagers take the remains of a young woman to a nearby graveyard.
The funeral procession on the tiny, overgrown footpath that splits Nsidza in Ntchisi is not uncommon.
Pregnancy-related deaths have persistently robbed the community in Ntchisi of its productive women and girls, the pillars of their families and communities.
At Nsidza CCAP, Reverend Emmanuel Mtepuka says funerals dominate his everyday work.
“Religious work and community development often come to a standstill as villagers spend lengthy times attending to funerals or sick relatives,” he says.
Health officials attribute the increased rates of pregnancy-related deaths to lack of knowledge and access to sexual and reproductive health (SRH) services, especially among the youth.
Almost six in 10 adolescents aged 15-19-year have ever had sex, studies show.
The situation is attributable to poverty, low levels of education and peer pressure.
While age at first sexual intercourse for women is declining, age at first marriage is increasing.
“The consequences of early initiation of sex are unwanted pregnancies, health complications, sexually transmitted infections [STIs], HIV, unsafe abortions, school drop-outs, and even deaths,” says Pilirani Ulaya, a midwife-cum-nurse at Ntchisi District Hospital.
She bemoans that early sexual debuts elongates the period adolescent girls practise sex out of wedlock.
“Limited education and lack of access to accurate information on sexuality leave underprivileged girls at risk of unwanted pregnancies, STIs, HIV and maternal deaths,” she says.
Women who marry early are more likely to quit school, to have more children than those who marry in their 20s.
But studies by the United Nations show half of Malawian women marry before their 18th birthday.
Communities often advise adolescents against premarital sex, but early sexual encounters and childbirths are widespread.
Quadria Muslim Association of Malawi (Qmam) is running a SRH project targeting 80 000 people under traditional authorities (T/As) Nthondo, Kasakula and Chikho in Ntchisi.
It works with young Malawians aged 10-24 years and women of child-bearing age, traditional leaders, clergypersons and politicians.
Qmam executive director Saiti Jambo is concerned that adolescents are silently excluded from accessing SRH services and information.
“Despite ongoing advocacy on harmful cultural practices that contribute to fertility rate, some cultural practices, including initiation ceremonies and child marriages, are some of the factors that shape community behaviours towards sex and reproductive health crises.”
Some people in Ntchisi still practice wife inheritance, called chokolo.
Malawi Demographic and Health Survey shows that a Malawian woman is likely to have four children in a lifetime.
Marrying girls aged below 18 is illegal, but the 2008 census shows that many Ntchisi girls marry aged 15 due to rampant poverty, illiteracy levels and harmful cultural practices.
Qmam is striving to reduce population growth and fertility rate by propagating use of modern family planning practices and increasing education attainment.
The organisation works closely with community leaders to ensure girls who quit school are re-enrolled and complete secondary education.
Project officer Faith Mapemba says Qmam is using families, village heads, religious leaders, health personnel, non-governmental organisations and schools to ensure every adolescent learns about sexual and reproductive health issues.
They have formed circles where the locals meet periodically to discuss SRH gaps and how to close them.
Dubbed Societies Taking Action for Rights (Star), the circles draw strategies and community-centred interventions to increase use and demand for SRH services, including modern family planning methods, in religious setups.
“The clubs have broken communication barriers of communication between the young and older members of the community,” says Mapemba.
The youth now freely discuss sexual issues with parents and religious leaders, she says.
The Reverend Fred Kambadzithe of the Baptist Church in T/A Kasukula concurs: “With the support of traditional leaders, we are reaching out to the youth with vital messages about SRH and gender-based violence.”
According to Jambo, Qmam engaged faith leaders to champion family planning, condom use and other health-seeking behaviours because lives of most Malawians are guided by religious principles.
Felia Evans, a member of the Star Circle in T/A Chikho, says use of contraceptives is increasing as the youth now know at least two family planning methods.
“The most preferred contraceptive method named was the pill and the injection. Very few mentioned sterilisation. Use of condoms for family planning is quite low, but high for preventing HIV.”