On a normal working day, a Health Surveillance Assistant (HSA) saw a woman coming, bleeding on her upper left arm.
This woman chose to have an implant method (Norplant) about a year ago and she was expected to have it removed after five years.
The HSA, Christopher Denesi of Mlomba Health Centre in Machinga, was shocked and had many unanswered questions when he noted that the woman was bleeding right at the point where the implant was inserted.
Checking her health passport, it was confirmed that she indeed had the Norplant, which was to be removed in four years’ time.
“She was not willing to explain anything. She was just crying. I noticed that her implant had been tampered with. She eventually disclosed that her husband was not interested in any family planning methods, so he was trying to remove it using a blade,” he explained.
Denesi admits that this has become common in the catchment area of Mlomba health facility in recent months, due to the culture of the area. This year alone, three women presented similar complications due to same reasons.
He observes that the latest woman tried to conceal the whole issue by treating the wound using home remedies, but it did not work out.
“There are a lot of unstable marriages in this area, so when a woman has an implant, they have it removed within a year as opposed to staying with it for the entire five year period. This is usually the case because the next husband might want to have a child with her,” he explains.
Community Volunteer for Ntaja Health Centre, Marriam Lolo, says most men do not allow their wives to use contraceptives because they feel their performance in bed is compromised.
“I think this is not true. I have used a Norplant since 2010. It was actually my husband who encouraged me to be using long term contraceptive methods. He said life has become expensive to take care of too many children,” she said.
Lolo’s duty as a community volunteer is to raise awareness about the benefits of family planning in the communities and try to clear out any misconceptions that might be there.
She says through her experience working in communities, she has realised that some men are against the use of family planning methods because of the connection to sexual performance issues.
“Some have confronted us claiming that since their wives began using contraceptives, their sexuality changed. But I believe that a woman is cold by nature and not because of the use of contraceptives,” says the 40 year old Lolo.
Family planning Coordinator for Machinga District Health Office (DHO), Elizabeth Katunga says though cases of men attempting to remove implant contraceptives are not alarming in the district, it is a health threat as this is done unprofessionally and the wound is prone to infections.
“At a health facility, we know how to handle it. We suspect that there could be many women who have experienced this kind of treatment but may not have presented their cases to us,” she says.
Family Planning coverage for Machinga is 46 percent and Katunga attributes this to misconceptions that people have towards it.
“People talk about it a lot and make decisions without consulting health workers… on issues of poor performance in bed, it’s more of a psychological issue. Most men talk about it among themselves and end up with a preconceived attitude towards contraceptives,” she said.
Katunga says through the community HSAs and volunteers; her office has tried everything possible to kill the negative perceptions that people have towards contraceptives.
Women using contraceptives in Mangochi are also silently facing the same challenges.
Family Planning Coordinator for Mangochi DHO, Joyce Chausa says, it appears to be an uphill battle to convince men to let their spouses use modern contraceptives.
“I remember handling a case where a woman was bitten by her husband, in his quest to remove an implant from her upper arm. The woman suffered in silence. She tried to conceal the wound until it began producing pus. The woman confessed about the whole ordeal after a lot of questioning,” she reveals.
Chausa says the woman never returned for another family planning method after receiving treatment for her infection.
“Despite such cases, we also have had a lot of women coming here with their spouses who are interested to learn about family planning. They are very inquisitive and even
request for alternative methods other than implants,” she says.
The contraceptive prevalence rate for Mangochi is 72 percent, which has increased from 64 per cent in the previous years. Chausa says most women from the ages of 20 to 34 prefer to use Depo Provera as compared to other contraceptive methods.
In Salima, even though the contraceptive prevalence rate has improved from 32 percent in 2008 to 53 percent in 2017, most women are using contraceptives without the knowledge of their spouses.
“As I’m talking to you right now, I’m keeping some health passports for some women whose husbands don’t want them to be using contraceptives. They are afraid that their husbands would check their health passports and they would be in trouble,” acknowledges Family planning coordinator for Salima DHO, Elizabeth Chalera.
Chalera says she would be happy if as many women (in reproductive ages) as possible were to use modern contraceptives, as maternal related complications in the district are too alarming.
According to Chalera, in 2016/2017, 30 women died of maternal related complications. But she says there is little or no involvement of men in family planning.
“The women say their husbands are afraid of the side effects of contraceptives. No man has come for vasectomy in the past six months; they just send their wives to the antenatal and others to access contraceptives,” Chalera revealed.
In her message for World population day, acting Executive Director for the United Nations Population Fund (UNFPA) Dr. Natalia Kanem says Investments in family planning can lead to prosperity for all. She also highlights that Family planning is critical to achieving Sustainable Development Goal one; ending poverty.
“It is also a key to achieving other Goals, such as ending hunger as well as promoting good health and gender equality…”
“Better reproductive health care, including voluntary family planning, can boost economies and contribute to sustainable development by empowering women to complete their education, join the paid labour force, be more productive in their jobs, earn higher incomes and increase savings and investments,” she notes through a press statement for the 2017 world population day.
The statement highlights that every day, vulnerable women, especially those who are poor and are refugees, face social, economic and geographic obstacles to voluntary family planning services and information.
It notes that despite the dramatic progress in family planning accessibility, enormous challenges remain.
Malawi has several partners that are supporting its family planning programmes such as UNFPA and DFID.
UNFPA has been supporting the Malawi government in family planning through capacity building and procurement of Family Planning commodities.
In 2015, the organisation procured drugs worth about US 7 million dollars, in 2016 it procured drugs worth about US 6 million dollars and in 2017 worth about US1 million dollars.
UK Aid, through DFID, procures supplies to meet Malawi’s family planning commodity needs.
Population Council report of December 2015 titled ‘Contraceptive discontinued: Reasons, challenges and solutions’ notes that some women discontinue a particular method because it is difficult to use, or its use is unacceptable to the woman or the partner (sometimes due to side effects).
“The engagement of male partners and enhancing couple communication about method characteristics can be effective in supporting continued use. Particularly in the postpartum period,” reads part of the report.
The report highlights that in Malawi, there is evidence that if men are made aware of economic advantages of family planning, they may be ready to support its long term use by their spouses or partner.