BY JOSEPHINE CHINELE:
At 18 years old, Ngellina is basking in winter sun outside a ward at Thyolo District Hospital whilst chatting with her step mother.
She is cracking jokes and sharing little gossip with the step mother and the rest of the patients and guardians who are also enjoying the warmth of the sun.
But one thing keeps coming to her mind, her future ‘happiness’ may be doomed; all because of a sexual relationship with her boyfriend which started mid last year, three years after she dropped out of school.
“I loved him so much. We had unprotected sex several times…I met him at the market where I sold vegetables for my grandmother. He is also a vegetable vendor,” she recalled.
When she fell pregnant, nobody from her clan reacted negatively as they simply accepted that this was ‘one of those things’.
“Some of our relations knew of our relationship except my father because I live with my grandmother in another area. They neither approved nor disapproved of our union. When I fell pregnant, we were regarded as an item even though we were not living together,” Ngellina, who is a Standard four drop out, said.
The Malawi Demographic and Health Survey (MDHS) of 2015-16 indicates that Malawi has recorded an increase in teenage pregnancies, from 26 percent (in MDHS of 2010) to 29 per cent, Ngellina happens to be one such case.
Ministry of Education, Science and Technology statistics indicate that national average for school drop outs due to teenage pregnancies is at 5.9 percent per academic year.
Ngellina claimed that she had only heard about birth control methods from her peers and other community members, but had never seen or tried any method.
“Honestly, I knew that I had more chances of falling pregnant after having unprotected sex. That’s what was emphasised at the initiation ceremony which I went through during my first menstruation…But I have never been exposed to any proper messages that talk about the use of contraceptives. I didn’t know who to ask or where to go. I knew there is a way one can prevent falling pregnant but not much about how this is done,” Ngellina, who looks younger than 18 years old, said.
But she declares that she had no regrets for falling pregnant before marriage because her family had seemingly accepted it. Her pregnancy was however not an ordinary one as she had difficulties to deliver the baby when she went into labour. Ngellina had prolonged labour and ended up having a to deliver through caesar.
Her baby, unfortunately, died of birth asphyxia. This condition usually occurs when a baby does not receive enough oxygen before, during or just after birth.
“I’m told the baby just cried once and died. I asked them [nurses] to let me at least carry my baby but they denied me this opportunity…I was deeply hurt. I’m struggling with the complications of having a C-Section wound yet the baby is gone,” she lamented.
Ngellina developed even more complications a few days later. The wound produced lots of smelly pus on the C-section wound two weeks after delivery. It was discovered that she had an infection and went through another operation, and had her uterus removed. She was still unwell and in a lot of pain, such that she was referred to Queen Elizabeth Central Hospital (QECH) where she had another operation.
Since April 11 2018, Ngellina has lived her life in hospital. She had been at QECH for a month after spending two weeks at Thyolo district hospital. She was referred back to have her wound taken care of at Thyolo district hospital.
“I’m aware that I will never have a child in my lifetime…This is so hard but I have no choice. It is every woman’s wish to have children… I wish I had delayed having children through contraceptives but as I have already said I didn’t know much about it…Here I am, the only child I would have had was disposed of as hospital waste and I never held it in my arms,” she lamented.
The whole ordeal has been on her mind despite the fact that she can crack jokes and smile with her friends and relations while basking in the sun on this Sunday morning.
Ngellina’s father, Bester Chikopa, of Njovu Village, Traditional Authority Khwethemule in Thyolo expressed sadness that his daughter will never have a child.
“This way a clan can’t expand… I’m also particularly worried that she might not even get married. It’s very hard for men to marry a woman they surely know will not bear them children,” he said, adding that the man who impregnated Ngellina is already showing signs of disconnection with her. He only visited her twice during the entire time she has been unwell. The father suspects that his daughter is unaware of the fact that her boyfriend knows of her predicament.
Chikopa then reveals that he has spent a lot of money -amounting to K25, 000- to buy various medications which were not available at the facilities his daughter was treated.
In his opinion, it is important for the youth to be given the opportunity to access contraceptives to prevent unwanted pregnancies and grave consequences like that of his daughter.
“Sex is natural and there is nothing anyone can do to stop youngsters from having it if they feel like having it. Much as every parent would want their child to abstain from sex, it’s better to give those that can’t options like condoms and a range of contraceptives to choose from,” he stressed.
Health Surveillance Assistant (Community Health Worker) for the area, Ethel Munthali said HSAs of the district have been trained on how to administer contraceptives, especially to the youth.
She disclosed that she is only limited to administering Depo-Provera and pills,
“There is no variety of contraceptives. Many teenagers don’t know much about the contraceptive choices that they have and I have been conducting awareness to enhance their knowledge and usage. We are usually not also provided with emergency pills,” she said.
Munthali added: “Another thing I have noted is that many teens are not free to ask for contraceptives because they feel they may be looked at as promiscuous people. We need a lot of awareness.”
Thyolo Active Youth Organisation (Tayo) Executive Director, Willard Mwambo, observed that contraceptives are not always available to the youth and they just make use of what is available at that particular time.
He also cites long distance to health facilities as one thing that discourages the youth to access family planning services, “A youth can’t walk five kilometers just to access a free condom…”
“There are inadequate Youth Friendly Health Service (YFHS) centres and service providers. There is also an issue of long queues, prolonged consultation time and judgmental attitude by some health providers,” he said.
He added: “There is also deep rooted myth that young people are not supposed to get contraceptives because they will become barren.”
Mwambo said his organisation has been conducting awareness sessions for the youth through youth clubs as a platform to convey sexual and reproductive health and rights messages. Counselling and guidance is also done at the organisation’s offices.
On his part, spokesperson for Thyolo district health office, Fanuel Makina said teenage pregnancies are a big issue in the district considering the cases that are presented for delivery at its facilities.
He added that Thyolo teenage pregnancy rate is at 38 percent and this is largely attributed to lack of access to contraceptives, poverty and contraceptive myths among others.
“We have own challenges such as lack of trained health personnel to deliver YFHS and inadequate infrastructure but the community’s myths are contributing to the problem. For instance, there is a strong belief that when teenagers use contraceptives, they become barren and will never have children in future. There is also a strong myth that contraceptives cause uterus tumors and that youths that use contraceptives are not good in bed,” Makina revealed.
Makina further said that the district has 28 primary health facilities and 14 of them have suitable infrastructure to host YFHS.
“But only eight are providing YFHS in full capacity. This is the case because we have inadequate providers to give the services,” he said.
White Ribbon Alliance National Coordinator, Nancy Kamwendo, said teenage pregnancies are a huge problem that the country is facing, attributing it to lack of information and access to contraceptives.
“Teenagers lack access to contraceptives due to stigma. Parents and the society at large don’t seem to accept that they also need contraceptives,” she observed.
Kamwendo noted that there is a provision of YFHS but it is not active in most health facilities, leaving teenagers with nowhere to go to access information and contraceptives.
“We all have a role to play otherwise this might worsen. Teenagers are resorting to having unsafe abortions because they are not ready for the pregnancies in the first place. There is need to prevent these pregnancies through contraceptives,” she said.
Ministry of Health acknowledged that teenage pregnancies are rampant in the country despite the fact that the ministry and other stakeholders are offering YFHS in health facilities.
The ministry’s spokesperson, Joshua Malango said youths that are sexually active can access condoms to protect themselves from sexually transmitted infections, HIV and pregnancy.
“They can get contraceptives after counselling. Ministry of Education teaches life skills which is age appropriate but you might wish to know that reducing the teenage pregnancies is not only the responsibility of the ministry, everybody (including parents, chiefs, communities, politicians, faith based organisations, media and the youths themselves) need to play their part too,” he emphasised.
Malango added that between July 2017 and April 2018, over five million youths (aged 10-24) have been reached with YFHS nationwide.
Malawi is one of the African countries that made commitments during the Family Planning London Summit (FP2020) in July 2012 to achieve a modern contraceptive prevalence rate of 60 percent by year 2020 from 33 percent for married and sexually active women, with a focus on reaching the 15–24 age group.
As for Ngellina, she is encouraging teenagers that are sexually active to consider using contraceptives as she had no chance to do so.
It is her hope that she would one day return to school once she is fully recovered, “I know that I can’t have children in my life anymore… I intend to go back to school. ..I don’t have a dream profession; I will do any job that will come my way as long as I will be earning a salary.”
If contraceptives are used:
* 555,000 unintended pregnancies will be presented
* 165,000 unsafe abortions will be averted
* 2,000 maternal deaths will be averted.
Source: Family planning 2020 document