In pictures: Increasing contraceptive care to young people in Malawi

Healthcare worker delivering CSE session.

Our Member Association, Family Planning Association of Malawi (FPAM), is delivering healthcare through the support of WISH* in Lilongwe and Kasungu with a focus on young women and girls. A bespoke training programme supports community health workers on how to deliver youth-friendly healthcare through outreach to local communities, and especially young women.

*The Women’s Integrated Sexual Health (WISH2Action) programme, is funded by the UK Foreign Commonwealth and Development Office (FCDO), under the strategy to ‘Leave No One Behind’.

Photographs ©FPAM/Andrew Mkandawire/Malawi


Barriers to contraceptive care

Young people, particularly girls, face barriers to accessing sexual and reproductive healthcare and contraception due to societal perceptions that they have no need for them.

Chiefs and parents in the Lilongwe and Kasungu districts have demonstrated that by working together they are able to meet this need and protect the health and wellbeing of young people in their communities. Their collective approach ensures elders advocate on behalf of the youth in their communities, encouraging them to feel confident in accessing healthcare provision and to counter myths and misconceptions about contraception. Their goal is to reduce the high number of unintended pregnancies and STIs among young people.

Gogo Nakwenda

Gogo Nakwenda is respected in her community as a go-to counsellor for young people, advising on sexuality and how to access healthcare.

Now nearing her 80s, Nakwneda, talks about different contraception methods, saying that if she was 18 again, she would opt for the five-year implant to ensure her education and future work opportunities. “During our time we used traditional contraception, but I have learned that modern pregnancy and sexually transmitted infections prevention methods are very predictable and give no excuses to protection errors. One can comfortably plan when to have a child and when not to have child.”

Lucy, volunteer and parent

Lucy believes it is important to educate both parents and young people on the benefits of access to contraception.

Lucy talks about how myths and misconceptions remain a barrier for young girls to be able to access contraception, mostly because of fears related to infertility. She is open about her own experiences with contraceptives. “I’m 38, I have used pills, injectables and now I’m now using the IUD and successfully I have given birth to three children and here I am in good health. Who else can lie about modern contraceptives? I usually encourage the young ones to be mindful of their future to avoid any mistake that could be prevented with available contraceptives they can comfortably demand from their community health workers.”

Chiefs Sadulira and Chinoko

Chiefs in Lilongwe and Kasungu districts are committed and supportive of the promotion of sexual and reproductive healthcare for the young people using the youth clubs they supervise.

Chief Sadulira believes this is a crucial time for parents to understand the importance of being open with young people. Connecting them with community health workers who are experienced in counselling and provision of sexual and reproductive healthcare can help reduce unintended pregnancies. “I use community meeting sessions to advise parents who resist or misunderstand why youth should have access to contraceptives, because prevention is better than cure.”

Matundu youth club

In July 2020, FPAM visited the Lilongwe and Kasungu youth clubs to support sexual and reproductive health behaviour change communication interventions.

“Our youth here access condoms from the chairman of Namangwe youth club who is linked to Chiwamba health center, located about 18km from Namangwe. He does all this as a volunteer because the area does not have any community-based distribution agents. And the fact that FPAM is finally here, we are assured that access to cervical cancer screening and contraception services are guaranteed,” says Chief Chinoko.

Ngwangwa

Ngwangwa applauded FPAM for bringing youth-targeted outreach clinics to their remote area and requested to increase the frequency of the clinics to reach more youth living in hard-to-reach communities.

“My area is big yet is leaning more like an island without a health facility nearby. It takes youth to walk 17km to get to Dzenza hospital, 15km to reach Ngoni health center, and 35km to get to Kabudula community hospital. This gap requires frequent mobile clinics.”

Ruth, youth leader

Radio and youth clubs are major sources of information on contraception as well as through community discussions and groups.

“I first heard about contraception in 2016, when I was 15, from Zodiak and MBC radios. I accessed the Implanon implant that protects for three years from one of the FPAM outreach clinics. In my family we are three girls and all my elder sisters fell pregnant in their teens. I never wanted to get disturbed to complete my secondary school education. And hearing from radios about the benefits of contraception like the ability to complete education made me generate confidence to have an implant to avoid unintended pregnancy.”

Banda, vice chair, Youth Action Movement (YAM)

The teams of youth leaders have successfully advocated for sexual and reproductive health and rights, creating demand specifically for contraceptive care in their communities.

“I engage in contraception discussions slowly by starting with a little probe if girls and young women have ever heard or used contraception before. Later I extend the discussion to give in that the unwanted pregnancy I got was total negligence because access to contraception services was available. I encourage them not to fall into unwanted pregnancy trap when they have all the support and preventative measures around."

Lucy, youth leader

Lucy chose a long-acting method of contraception through the FPAM mobile outreach clinic.

“My friends discouraged me a lot because they feared a rumor that the IUD drops into the uterus and causes cancer. I gathered courage because I needed a solution that would enable me not to conceive again until my family's economic status improves, and I got the IUD fitted. I feel no problem. This evidence is now a tool I use to teach many girls and women about the benefits of contraception. We are really glad to have FPAM bring a youth-friendly mobile clinic which will support our ground efforts to advocate for youth access to all sexual and reproductive health and rights information and services.”