Maternal and Neonatal Challenges
Between 2008-2015 Kwitanda Community recorded maternal deaths and infant mortalities from birth each year. These maternal and newborn deaths are largely preventable with access to quality health care facilities. Yet for geographic, economic, and religious reasons many women do not deliver at facilities. The average distance to a safe delivery-equipped health facility in Kwitanda area is approximately 20 km (Some pregnant women have to travel 30 km over un-paved roads).
Efforts to reduce maternal deaths and infant mortality have been done through creating Community Action Groups in the community. This community-based intervention known as Community Action Groups (CAGs) was implemented to increase coverage of maternal and neonatal health (MNH) services among the poorest and most remote populations at Kwitanda.
The challenge is that the CAGs did not include the youth. For the past few years, several CAG review meetings concluded that teenage pregnancies in the area were on the rise which is a risk factor for increased maternal deaths. The rise in teenage pregnancies was confirmed by data collected at Static and outreach ANC clinics at Kwitanda health center from 2017 to 2021 and Dziwe health center in 2021. It also agreed with data collected from Community Based Maternal and Newborn Care program which is conducted by Health Surveillance Assistants by visiting pregnant women and newborn babies in their homes. The following table shows the proportion of teenage pregnancies recorded on a monthly basis for a 12 month period between 2020 and 2021.
Kwitanda Facility Deliveries from October 2020 to September 2021
% of teen deliveries
Raise in Teenage Pregnancies
On average 28% of women delivering between October 2020 and September 2021 in Kwitanda catchment area were under the age of 20, which is slightly lower than 29% of national teenage pregnancy. Teenage childbearing generally declined between 1992 (35%) and 2010 (26%) before increasing slightly in 2015-16 (29%). In Malawi, 29% of women age 15-19 have begun childbearing; 22% have had a live birth and 7% are pregnant with first child (DHS 2015-2016)
Most of these teenage pregnancies were delivered at home and TBAs ending into stillbirths and also in several abortions. And again most of the home deliveries are teenage mothers who lack information about pregnancy safety. These teenagers have no information about .1. Family planning services. 2. Antenatal care. 3. Clean and safe delivery (skilled attendants and Ministry of Health requirement to deliver at health service). 4. Essential obstetric care.
To reduce teenage pregnancies, advocacy and awareness on the prevention of teenage pregnancy have to be carried out in collaboration with the relevant stakeholders through a multi-sectoral task force. That was why MaiKhanda in collaboration with other stakeholders decided to conduct an open day to enhance public awareness for teenage pregnancy and how to combat its spread.
The Open Day
The opened day was held on 25 November 2021 at Mang’ombo Primary School ground in Sub-Traditional Authority Mpirisi – Balaka district. The theme of the open day was “To share knowledge with young people so that they are empowered to combat teenage pregnancies in the area.”
The Open Day was attended by different stakeholders and other implementing partners. Among notable figures at the event include; the guest honour at the event was Linda Mwapasa the chair at the District Council. Director of Administration for Balaka district council, MNH Matron, Youth Health Services Coordinator, District Youth Officer, ED Nkhadze Alive Youth Organization and Director of Programs from MaiKhanda Trust.
The main activities at the event include, speeches, open and direct questions, case studies, drama, poems, songs, motivational talk, Pavilions and football Bonanza.
The youths together with other community members expressed their concerns through poems, songs, drama and speeches. The main concern was poverty, due to poverty young girls indulge in different mal-practices in search of money resulting in girls getting pregnancy at a teen age. The chairperson of the Youth Networks added that lack of vocation training centres and recreation materials in youth centres contribute to keeping the youth idle and result in early marriage and pregnancies. As such stakeholders and other partners in the district were urged to financially support with small-scale businesses for the youth who are just staying idle in the community.
Youth Empowerment and Encouragement
The distinguished guest and community leaders present at the event empowered and encouraged the youths through different speeches. It started with a motivation talk by a notable musician who is one of the role models for Balaka district Mr. Charles Sinetre. He is also an Executive Director of Nkhadze Alive Youth Organisation (NAYORG) a local organization in Balaka. His motivation talk was phrased as “road to success in the face of poverty”. He explained his own personal life as a Youth of his time, how he navigated poverty while remaining focused on education and how he made his success. Sinetre encouraged the youths that with determination and prayer, they too can succeed in life. For this to materialize youth should refrain from all immoral behaviours such as drug abuse and sexual indulgence.
District Youth Officer from the district council Loveness Masauko thanked MaiKhanda for blowing the whistle to the District assembly on the rising of teen marriages and pregnancies in Kwitanda area. She also commended the collaboration that has been there during preparation of the program and also requested for a continued collaboration to the follow up programs. She then asked the youth to listen to the different speeches and messages disseminated to them at the open day so that they can make future good leaders but only if they go to school. The youth were also asked to courageously whistle blow to the authorities for anything they see that deprives them of their rights to education and good health.
Local leaders pleaded with the youths, parents, and guardians for mind-set change in tolerating some of these behaviours. Group village headman Mpirisi urged the youth to be reliable citizens in developmental aspects. The chiefs pledged their solidarity to enforce by-laws to punish conduits who force adolescent girls into early marriage.
The YFHS coordinator Daniel Mika urged the youth to focus on their goals especially education and enhancement of their capabilities because they are reliable assets of the nation. Mika encouraged young people to attend youth corners at health facility to discuss most health issues affecting them. Abstaining from indulging in immoral behaviors that can lead to un-intended pregnancies. Youth were further encouraged to access primary prevention services for Sexually Transmitted Infections like family planning services from all health service delivering points. Youth were empowered to report to authorities’ any issue pertaining to gender-based violence. The adolescent girls were warned about dangers and complication of teenage pregnancies. Some complications include; fistula, rupture of uterus, stigma and discrimination and psychological trauma.
MaiKhanda’s Director of programs, Edward Moses, thanked the audience for taking part in combating teenager pregnancies. He further highlighted that young people have a task to make a right decisions pertaining to their health and their future. As sole partner in MNH and SRH in the area, MaiKhanda will continue to render support for youth activities till they reach their goals. He recommended that youth should realize that they have a responsibility to prevent early pregnancies, Moses said youth should refrain from being forced to do things they don’t want example early marriage. He continued by saying that poverty should not be an excuse for indulging into unprecedented behavior. He asked the youth to make use of the open day to access the health services which were being showcased like contraceptive methods to reduce the challenge of teenage pregnancies.
People in the community were instructed to report to the district council any act against the youth. The remarks were made by the Director of Administration for Balaka district council Mr. Darwin Mngoli. At the event he was representing the District Commissioner. He also requested the chiefs to support the youth in their endeavors to combat spread of teenage pregnancies.
The guest of honour Mrs. Linda Mwapasa, the Balaka District Council chair person, put to caution girls as they as accessing contraceptives they should also be aware of sexually transimited infetions and means of preventing such. She requested the health care providers to advise the youth whenever they are choosing contraceptive methods because some of the methods will protect them from pregnancy only while some methods will also protect them from contracting STIs. Mwapasa demanded parents to allow the youth access the contraceptive methods. In responding to the concern raised by the youth, the guest of honour asked the Councillor of the area to assist the youth with income generating activities. She appealed to the Councillor and implementing partners to revamp youth centers with different equipments that can keep the youth busy. She also asked the youth to take the message the good messages from youth clubs and at the open day to their friends in the villages. On her final remarks she emphasized that young people need motivation such as employment and good education, youth must be given school bursaries for them to accomplish education. Thanked MaiKhanda Trust for organizing such an event which elevated public awareness on issues affecting the community.
Two pavilions were raised at the event, one from Baylor and the other from Balaka district hospital family planning department. These pavilions showcased different contraceptive methods, HIV test kits and drugs for PEP. In addition, approximately 50 youth members accessed the contraceptive methods during and after the event.
The event was spiced by placards that displaced various messages addressing the challenges of the youth.
T shirt, banner, Placards and pavilion graced the ceremony. A young musician. Malamba, was also there to act as a crowd puller for the youth. Football bonanza at the end of activity also spiced up the event.
MaiKhanda Trust is a Malawian non-governmental and nonprofit organization established and registered under Trustees Incorporation Act in 2006. MaiKhanda works with the Ministry of Health and all partners and stakeholders in Maternal and Neonatal Health service delivery.
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