11 JULY 2013

No children by children P2

From high fertility to contraception P4 A womans struggle against early marriages P5

STOP ADOLESCENT PREGNANCIES

Special pullout THE nation 11 july 2013

by Edyth Kambalame, Features Editor

oday, Malawi joins the world in commemorating World Population Day. This years theme, Adolescent Pregnancy, focuses on raising awareness on early pregnancy in the hopes of delivering a world where every pregnancy is wanted, every child birth is safe, and every young persons potential is fulfilled, according to the United Nations. Locally, Malawi has gone further to extend the theme to be Stop Adolescent Pregnancy: No Children by Children. Indeed, it is unacceptable for children to have children of their own. In Malawi, pregnancy and childbirthrelated complications are the major cause of death among girls between the ages of 10 and 19, while the highest rates of sexually transmitted infections are among young people aged 15 to 24. The fulfilment of adolescent girls rights remains a challenge in Malawi. Adolescent girls are among the most vulnerable sub-groups of people in the country. Many of them are vulnerable because they live in remote areas, lack access to jobs, education, healthcare, are voiceless, they are victims of harmful cultural practices such as child-marriage and are more likely to get infected by HIV and Aids compared to their male counterparts. Worse still, the high maternal mortality rate and occurrences of obstetric fistula in Malawi are aggravated by child marriages, poverty, dropping out of school and early child-bearing. Fortysix percent of all new HIV infections in Malawi occur among the youth, with young women three times more likely to be HIV-positive than young men their age. All this is exacerbated by poor access to Sexual and Reproductive Health information and services by girls. In addition, coverage of youth programmes appears to be disproportionately focused on late adolescent girls (1519 year olds), with adolescent girls not adequately covered. Adolescent pregnancy is not just a health issue, it is a development issue. It is deeply rooted in poverty, gender inequality, violence,

No children by children
child and forced marriage, power imbalances between adolescent girls and their male partners, lack of education, and the failure of systems and institutions to protect their rights. Breaking the cycle of adolescent pregnancy requires commitment from nations, communities and individuals in both developed and developing countries to invest in adolescent girls. Around the world, about 16 million girls under age 18 give birth each year and in Malawi, the 45 percent of girls are likely to get pregnant before the age of 18. Most of these pregnancies are unplanned for, and they often result in unsafe abortions. This status quo is also a result of early marriages, as the UN estimates that 90 percent of the pregnant adolescents in the developing world are married. But for many of these girls, pregnancy has little to do with informed choice. However, it is not only young girls who are victims of this knowledge and resource gap. According to the 2010 Malawi Demographic Health Survey (DHS), 41 percent of women in the country have an unmet need for contraception, keeping them from planning the number of children they want to have and when. Adolescent pregnancies are a pointer to the vulnerable situation that women find themselves in most developing countries. As girls drop out of school and grow into women who have to provide for their families, they face further challenges such as lack of access to land, credit, and

Teenage pregnancies are a major setback to development, especially in Malawi

education, making it harder for them to provide for their families. The UN Food and Agriculture Organisation estimates that if women had the same access to these services as men, global
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FACTS

FAST

l The world population is now over seven billion. l Every second, five people are born and two people die, a net gain of three people. At this rate, the world population will double every 40 years and would be 12 billion in 40 years, 24 billion in 80 years, and more than 48 billion in 120 years.

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Special pullout THE nation 11 july 2013

STOP ADOLESCENT PREGNANCIES

special essay

Malawi wants to reduce early pregnacies

PAGE 2

malnutrition could be reduced by 12 to 17 percent, and more girls would stay in school, thereby increasing their future prospects. But committed groups around the world are highlighting the connections between population growth, gender, reproductive health, agricultural production, and environmental sustainability and the need for integrated, holistic approaches to ensure people have their desired number of children they can support and feed, and more importantly, that they have children when they are ready to do so. For example, one of the new initiatives launched at the 2013 Women Deliver Conference, It Takes Two, is aimed at raising awareness of, increasing demand for, and improving access to family planning information and services around the world. It Takes Two recognises that if the status of girls and women is to change, there is need for concerted efforts from men, women, communities, governments and other stakeholders. It highlights the need for young men and women to take action in support of improving access to family planning services and information, put pressure on governments to reach their Family Planning 2020 commitments and be catalysts for significant progress and change. For Malawi, there seems to be a lot of political will to move in the right direction. President Joyce Banda strongly emphases on family planning, girls education and womens economic empowerment, all of which are likely to contribute to further demographic changes. Add to this to the commitment that government made at the 2012 London Summit of Family Planning, like the approval of the National Population Policy (NPP) which has since been launched, turning the Ministry of Healths Reproductive Health Unit into a full directorate, and creating a budget line on family planning have already been honoured.

Girls make a strong statement against early marriages through a placard

Keeping girls in school can help reduce population growth Government needs to offer continued leadership in ensuring that the remaining commitments from the London Summit are honoured. One of the commitments that is yet to be met is reviewing the marriage age for girls to 18. Yes, there is still a lot of work to be done, such as ensuring that the NPP is not just on paper; that more women, especially in rural areas, have skilled healthcare during pregnancy and childbirth; and most importantly, that early and unwanted pregnancies are prevented. But the demonstrated political will should catapult each one of usfrom government, policy makers, civil society and communities to play our role in ensuring a brighter future for the Malawian female adolescent!n

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STOP ADOLESCENT PREGNANCIES

Special pullout THE nation 11 july 2013

FEATURES
JAMES CHAVULA News Analyst

stelle Charles and Charles Jubeki are no ordinary couple in Mwanza. They exacted the countrys concealed desire for every couple to have four children when they delivered quadruplets last year. In a country with the fertility rate of slightly over five children in a womans lifetime, the quadruplets born at Mwanza District Hospital, a first in the border district, meant the lowincome residents of Tuwale Village in the hills of Thambani have to struggle even more to raise seven children amid financial woes facing their family. Throughout the tale of the quads birth on June 16 last year, one thing was clear: The farming family which also depends on vending handmade pots already had a daunting task to raise three childrena five-year-old and three-year-old twins and they would require relief items, including clothes, blankets, foodstuffs and other basics to sustain the quads lives. If it were not for the death of their first set of twins about 10 years ago, the arrival of the foursomeTiyanjane, Tiyamike, Chimwemwe and Davisthe woman could have been struggling to raise nine children at age 24. But as one of her miracle newborns are learning to stand in the middle of lingering shortages, the woman and her husband have crawled from what struck them as a curse to embrace family planning. Of course, it was painful to discover that I had given birth to four children because my husband and I did not have the capacity to take care of the quadruplets. We were already grappling with the other three, said the woman when The Nation paid her a surprise visit last week. The uncertainty that engulfed their household could be the price couples pay for high fertility rate and poor family planning. T/A Kwataine of Dedza, who chairs the Presidential Initiative for Safe Motherhood, affirms that it is better to have fewer children with quality upbringing, health and education than more exerting a burden on limited resources. Almost toeing this line of thought, the Charles have arrived at a consensus that they need to do something to end further problems resulting from their bulging brood. Barely, months after hogging

From high fertility to contraception

Estelle Charles and her quadruplets

the limelight on the back of the quadruplets arrival, which left the woman severely depressed for days, experience has compelled them to seek a final solution to their agony by seeking vasectomy, a contraception measure that will help curb further births. In a rare show of mens support for women, the husband told The Nation that they have decided not to have more children for the wellbeing of the mother and their seven children. Jubeki Charles explained: It will be difficult for me as a breadwinner to meet the daily needs of the childrenclothes, food and education. I am also considering the health of my wife. Apparently, the couples fertility has been increasing sharply since the death of their firstborn twins. Five years ago, they gave birth to one child. Two years later, they welcomed twins. This time, they have quadruplets. With the increased number of children straining their income and well-being, the 24-year-mother says although her health and livelihood is improving, she cannot continue bearing children because it is taxing to take care of them. In an interview, Mwanza District Hospital spokesperson Tawonga Mafuleka said the couple adopted the contraception method following heart-to-heart discussions with themselves as a couple and health workers as guides. In this regard, the path they have taken could be cited as one of the milestones resulting from their relocation from their rural setting where Thambani Centre, the nearest healthcare facility, failed to handle the birth of the quadruplets. During a rally in Mwanza in June last year, President Joyce Banda ordered the family to transfer to Mwanza because the rural health centre could not handle the post-natal needs of the four children. However, poor access to contraceptives and family planning in formation remains a major setback to efforts towards

making sure that children are born by choice and not by chance. The 2009 Malawi Demographic Health Survey highlights gaps in closing the shortfalls. Although access to contraception increased from 13 percent in 1992 to 46 percent in 2010, the findings show 26 percent of married women who want to postpone their next birth or stop childbearing altogether are unable to access or use contraception. The unmet need is overwhelming in rural areas. Apart from gaps in circulation of contraceptives and information, the country is still PAGE 5

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Special pullout THE nation 11 july 2013

STOP ADOLESCENT PREGNANCIES

FEATURES

Story of Mwanza quadruplets

PAGE 4 relying on the National Population Policy of 1994 which Chancellor College population expert Jesman Chitsanya dubbed as outdated. In 2010, an amendment of the policy proposed four children per couple to curb the rising population growth, with Finance Minister Lipenga quashing the Human Rights and Consultative Committee (HRCC) suggestion of two children a family. Other countries such as China, prescribe onechild policy. While Malawi looks indecisive on the policy, census trends show the population grew from about three million in 1950 to 15 million in 2008 and a 2010. The UN World Population Prospects shows the figure will reach 50 million by 2050 and more than 120 million by 2100. This growth is mostly driven by high fertility, which has declined modestly from 7.2 children per woman in 1970 to 5.8 children per woman in 2010, reads MDHS report. The current population represents a 32 percent jump from about 10 million enumerated in 1998 and a 2.8 percent annual growth rate, a boom that heightens a scramble for limited resources. The fertility rate means that every couple is likely to have six children on average, calling for smaller families and intensified efforts to bring family planning options closer to the people. Last year, President Banda campaigned for increased access to contraceptives, citing high fertility rates as a development challenge. It is time policy talk gave way to concrete action.n

Unwanted pregnancies contribute significantly to rapid Malawis population growth from almost four million in 1966 to about 15 million this year. With the UN population projecting the figure to reach 23 million in 2025, JAMES CHAVULA traces T/A Chiteras footprints in ending unwanted pregnancies and early marriages.

A womans struggle against early marriage

There it is. Just on the margins of Blantyre City: A sprawling population of girls with the great likelihood of dumping school for two paths that lead to worsening poverty. In a poor country where girls sometimes marry when they are slightly over 15 years old and face the grim probability to have about six children in a lifetime, their story could be just a caption of the ruinous effects of rapid population growth. A majority of them march unknowingly on the footpaths that connect the districts remote areas: Early teens carrying babies on their backs and their age group grappling with pregnancies that may culminate in childbearing moments likely to endanger the wellbeing of the girls barely ready to take care of their fellow children. Chiradzulu is a very tricky place for the Malawian girls chances in life, said district commissioner Andrew Misomali at the commemoration of the Day of the African Child last month. Unless she is adequately motivated to remain and excel in her education pursuit, she will be carrying an early pregnancy or destined for the neighbouring city to work as a housemaid. In a world campaigning to contain population growth by ensuring there are no children for children any more, Misomalis concerns could be just an episode in a graver story that transcends time and place. However, newly elevated Senior Chief Chitera is spearheading traditional leaders involvement in the emerging struggle to curb population growth and practices which predispose children to what a population expert recently denounced as an appalling violation of human rights which PAGE 6

Girls need to make a bold decision to remain in school

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STOP ADOLESCENT PREGNANCIES

Special pullout THE nation 11 july 2013

FEATURES

Chitera set to end early marriages

PAGE 5 does not only rob girls of their education. A girl who is married as a child is one whose potential will not be fulfilled, says Babatunde Osotimehin, UNFPA country director in Nigeria. Nothing sums up the effects of marrying prematurely than physician Osotimehin. The early marriage culture widespread in Chiradzulu denies a girl of her childhood, disrupts her education and limits her opportunities in life. At worst, it defeats the quest for children by choice, not by chance, thereby jeopardising her health and increasing her vulnerability to birth complicationssuch as fistulaas well as to violence and abuse. It is with commitment to protect girls and their rights that Chitera put in place bylaws stipulating sanctions for couples and suitors who coerce school-going girls into marriage. When I started campaigning for girl empowerment in 2011, my area had the highest rates of early marriages, school dropouts and poverty in the country, says the chief, who requires those who contravene her by-laws to pay live goats and other livestock. Some civil society organisations denounced the sanctions as trading a girls life with livestock, saying no girl is worth a goat. However, they have become a role model of how traditional leaders can help create a safer world for girl pupils. My heart will rest when girls are marrying after attaining 21 years old, says Chitera. A seventh born in a family of 13 children, the chief is a human face of the burden bloated broods and booming population exert on the rural poor households. She had to forgo basic education as her parents struggled to sustain the but there is need for more awareness and to make the readmission process simple so that more young mothers return to school, said Mkandawire. Despite parity in numbers of girls and boys in Standard One, the country has high dropout rates in higher classeswith UN figures showing only one in seven girls makes it to secondary school. If that is alarming, the fertility rates will be a perfect call to action. The 2012 Unicef report shows that almost half of girls in the country are married before the age of 18. Hinting at a further population bulge, the latest national census shows a Malawian woman is likely to have about six children in a lifetime. While President Joyce Banda rightly stated that these fertility trends hinder efforts towards reducing pregnancyrelated deaths as well as a population boom, there is no consensus on the right marriageable age. In 2009, Parliament amended the law to ensure that girls who were only legally due for marriage with parental consent at age 16 can only do when they reach 15. President Bingu wa Mutharika referred the law to the drawer for further consultation as one section of the society wanted the marriageable age to be aligned with UN Convention on the Rights of Children which stipulates 18 or above. We are advocating the review of the Constitution so that the minimum age for marriage should be 18. Children have spoken that they want the marriage age to be 18. We want chiefs to put in place by-laws that people who marry children early, says Mary Shawa, the principal secretary for the Ministry of Gender, Children and Social Welfare. This confers status on the efforts Chitera and company are taking to save the Malawian girl.n

Chitera: I want girls to marry at 21

livelihood of the bloated brood amid dwindling income levels. To close the gap created by poor early childhoodcare and education, the traditional leader recently enrolled into adult literacy classes. She does not know when she was born and only suspect it was 1954. Welling from a firsthand experience of effects of poor education and population growth on girls, her girl empowerment is never short of praise. Joining the fray, Chiradzulu district social welfare officer Mike Maulidi praised the chief for championing the community-led sanctions to lessen harmful practices which account for low numbers of girl pupils in higher classes. Maulidi reckoned that by adopting measures of safeguarding children from marriages, the custodians of culture are boosting the retention and success of girls in school. He explained: Chiradzulu used to be a risky place for girls education and upbringing due to widespread harmful cultural practices that encourage them to quit school and marry. T/A Chitera is a shining example of partnerships which are influencing change at the grassroots. Although increasing awareness and community involvement is helping wipe out incidences of early marriages, Misomali said the strides are being eroded by farm owners who engage girls as tenants and city dwellers who conscript them to work as maids. Coalition Centre for Alternatives for Victimised and Orphaned Children (Cawvoc) and

Girls Empowerment are some of the civil society organisations working in Chiradzulu. GEP communications adviser Joyce Mkandawire called for improved civic education and simplified procedures to ensure girls that quit school due to early pregnancies ultilise the second chance offered by the Readmission Policy government adopted in 2009. Experience shows that girls that go back to school after quitting due to pregnancy play a vital role in warning the younger ones to desist from sexual activities,

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Special pullout THE nation 11 july 2013

STOP ADOLESCENT PREGNANCIES

FEATURES
Emmanuel Muwamba

Staff Reporter

mily Chinena from Neno District beamed with joy as Minister of Water Development Brown Mpinganjira and Japanese Ambassador Fujio Samukawa cut the tape marking the handover of 119 boreholes. Her joy, she said, stems from the departure to using water from unprotected sources such as shallow wells, rivers and springs. We have today said goodbye to using water from unprotected sources. The community will now enjoy safe water, she said while a group of elderly women danced and elated at the handover of one of the 119 boreholes drilled in Neno and Mwanza. But Chinenas face changed when asked how many people would benefit from the borehole. There will be 1 758 people that will directly benefit. As you can see that number, by far, exceeds the recommended standard of 250 people per borehole, explained a worried Chinena. But we will have to camp here at whatever time to access safe water. She stated that in recent past the population of the area and that of the district grew steadily putting pressure on natural resources such as forest and water. Rapid population growth has placed increased demands on natural resources such as land, forests and water. The well-being of the majority of inhabitants is dependent on natural resources which are highly vulnerable to climate change, said Chinena. Neno had 80 000 people when it was split from Mwanza in 2003, but today it has 137 000 inhabitants. In 2030, it is expected that Neno will have 284 000 people, according to the National Statistical Office. The growing population is worrying Chinena. She says access to basic services such as water faces a new challenge not

Population pressures access to safe water

This is how to do it: Chinena shows how a borehole works

debated in the past. I am an old woman, but we encourage young mothers to guard against having too many children. Resources are becoming scarce, she said. Malawi is one of the 15 countries categorised as a population and climate change hotspot because of its rapidly growing population, water scarcity and falling food production, say African Institute for Development Policy (AFidep) and Population Action International (PAI) in their 2012 report Population Dynamics, Climate Change and Sustainable Development in Malawi. Malawis population has grown from six million in 1966 to about 15 million now and the United Nations Population Division projects that it could more than triple to 50 million by 2050, and reach 129 million by 2100. This population growth is due to high and slowly declining ertility levels. The number of births per woman is currently 5.7, says the report. Despite the links between population, climate change and sustainable development, there is limited effort to address the two issues in Malawi. There is no climate change policy currently in place although they have begun to develop one. Both climate change and population dynamics have been identified in the Malawi Growth and Development Strategy II (MGDS II) 2011-2016, the national development blueprint, it adds. Malawis population density of 126 people per square kilometre is among the highest in Africa, and it will grow six-fold to 803 people per square kilometre by 2050, says API and Afidep. Mpinganjira, in his address, acknowledged that the 119 boreholes drilled in Neno and Mwanza to benefit 28 000 people might not be enough for the entire population, but he said government is trying to bring safe water closer to people in the country. Currently, at least, 80 percent of the Malawi population has access to safe water. Mpinganjira said the 119 drilled boreholes, valued at 426 million Japanese yen (about K1.53 billion) will enable people of the two districts access safe water. This intervention is critical towards poverty reduction and improvement of the quality of life of rural communities as is enshrined in the Malawi Growth and Development Strategy which places water development and irrigation in its priority areas of intervention. It is my belief that this contribution will go a long way in helping Malawi towards achieving the Millennium Development Goal number 7 which aims at providing access to water and sanitation to half of the population that does not have access to safe water and sanitation facilities by 2015, explained Mpinganjira. Samukawa applauded government for continuously putting in more efforts to ensure that safe water is accessible to the people. This has tremendously increased the national water coverage to 83 percent as reported in the 2012 Joint Sector Review Report. This is no mean achievement as it is above the Millennium Development Goal target of 74 percent, he said. Prior to the project, only 44.7 percent of the

100 997 population in Mwanza and 38.6 percent in Neno had access to safe and clean water, said Samukawa. The rest drew their water from rivers, springs and unprotected shallow wells. This had a negative impact on people. One of the notable sad moments is the loss of 20 people caused by water-borne diseases, he said. President Joyce Banda on Saturday, July 6 at the commemoration of 49 year of independence admitted that population growth has put pressure on the countrys natural resources and other basic services. Unless the issues of population growth as projected by the NSO are addressed, access to basic services such as water may remain a challenge to most inhabitants in the country, especially women such as Chinena in Neno.n

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STOP ADOLESCENT PREGNANCIES

Special pullout THE nation 11 july 2013

FEATURES
Policies that can make girls stay longer in school, writes EPHRAIM NYONDO, can be a rewarding panacea in combating the challenge of population growth in Malawi.
Malawis population has grown rapidly from almost four million in 1966 to 14.8 million last year. UN population projections further warn that figures could easily reach 23 million in 2025 and 37 million in 2050 if families continue to have, on average, six children. Already, the trend has not just resulted in the destruction of the environmentthe mark of climate change. Economicallyargues economist Thomas MunthaliMalawi loses K32 billion of GDP every year to unsustainable use of natural resources because of unchecked population growth. Of course, population growth should not just be seen from a negative prism. In 1965, Emily Boserup, a Danish economist, pushing necessity is the mother of all invention theory, asserted that an increase in population would stimulate technologists and scientists to increase food production. Any increase in population would increase the demand for food and so act as an incentive to change agrarian (farming) technology and produce more food, she wrote. What with the genetically-modified foods (GMO) and various agricultural technologies the world has witnessed since the 70s? In fact, Boserups descendants, using the instance of the rise of Chinathe world most populous nation, further argues that a big

Containing population by educating girls

A girl speaks against early marriages and teenage pregnancies

population is necessary because it provides enough labour and market for production processes. But for a country such as Malawi, whose production capacity is low and almost 80 percent of people are rooted to a small piece of customary land and deriving livelihoods from rain-fed agriculture, containing population, says Martha Kwataine, executive director of Malawi Health Equity Network (Mhen), is a must. We must do this or our development agenda will be derailed she says. But how can Malawi achieve that? Containing population, arguably, begins by understanding what fuels it. Research shows that Malawis population rise stems from two sides of a single coin. One, a decline in mortality experienced since the 1950s due to improvements in nutrition and health care, and two, stubbornly high levels of fertility rate that have remained unchanged since 2004. Being a national achievement, the decline in mortality is nothing to fight against. But it is the fertility rate that Malawi needs to contain in its drive to curb population growth. Malawi is among the least developed countries with high fertility and rapidly growing population, high levels of unmet need for family planning. With an annual population growth rate of 2.8 percent, 5.7 children per woman, 139 people per square kilometre, Malawi has one of the highest growth rates and is among the most densely populated countries in sub-Saharan Africa, says Munthali. There could be a number of reasons at the heart of Malawis high fertility rate. Most experts, however, point mostly to the countrys high cases of child pregnancies and early marriage. In Malawi, nearly 50 percent of girls, 2010 Demographic and Health Survey (DHS) shows, marry before they are 18 years old. In fact, one in seven across the country, especially in the rural areas, marries before they reach 15. To mean, if a girl is married off or gets pregnant at 15, that marks the end of her educations journey. This is why the 2010 DHS shows that fewer than one in five girls make it to secondary school. Most of them end up depending on their husbands: the mark of deepening poverty among women and also gender-based violence. According to the 2012 WHO data, there is a direct link between keeping girls in school and boosting nations economiesremember Malawi loses K32 billion of GDP every year to unsustainable use of natural resources because of unchecked population growth. Consider the vicious circle: An extra year of primary school boosts girls eventual wages by 10 to 20 percent. An extra year of secondary school adds 15 to 25

percent. Interestingly, adds the WHO report, girls who stay in school for seven or more years typically marry four years later and have two fewer children than girls who drop out. Unarguably, education, then, can be a critical factor in containing the countrys high fertility rate. This is why the No Children for Children theme for this years World Day for Population reflects the deeper connection between population growth, teenage pregnancy and early marriages. But more, arguably, need to be done, especially in keeping girls in school not just from the gender equality lens, but also from the perspective of containing population growth.n

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