Covid-19 and Malawi’s Youth: What could have gone wrong?

By Jonathan Thanthwe Mbuna

Malawi may have been spared actual morbidity and mortality due to COVID-19 but there is a generation of young people that has been deeply affected psychologically. As the late Martin Luther King once reminded us, psychological death is more painful than physical death. These youth have lost a great deal due to COVID-19 and the sad reality is that things could have been done differently to avert this catastrophe.

To date, only 181 people have died of COVID-19 and the total confirmed cases stand at 5,829. The direct and indirect effects of COVID-19 on the youth far outweigh the so-called minimal effects of COVID-19 that we are lauding. In just 6 months, from the time the first COVID-19 case was detected in March, to August 2020, about 44,874 teen pregnancies were reported in some districts and 12,995 child marriages were reported (Assessment report 2020 by Malawi’s Ministry of Gender, Community Development and Social Welfare).

These figures raise the issue of what should be done now and what could have been done differently. In a country that already has a high population, this should be seen as a  worrisome development. The other alarming effect was on the education of the girl child. These will have far-reaching repercussions for years to come.

While it is true that COVID-19 is partly responsible for attributing to the increase in teen pregnancies and child marriages, it can also be argued that COVID-19 has just exposed the neglect the society has made on some underlying issues. With COVID-19, outreach clinics targeting the youth were scaled down leading to low condom use among youths as some youths reported in Blantyre. Further, with COVID-19, youth were at home and not in schools and hence due to idling, some youths were tempted to engage in unprotected sex.

However, this was just a symptom of pre-existing underlying issues of lack of proper parenting skills in some societies, lack of comprehensive sexual and reproductive health knowledge and skills among both the youth and their carers, low uptake and use of contraceptives and peer pressure a belief among young.  people that marriage is an easier alternative to hard work in school.

The other major factor leading to the explosion of teenage pregnancies and marriages as advanced in the recent study by ministry of gender, community development and social welfare is that of cultural and socialization processes. This is deeply entrenched in both Christian and Islamic communities which account for over 90 % of Malawi’s population. Boys and girls are socialized into the belief that being in marriage is the highest achievement in life, and they aspire to it. The earlier they can do that the better.

While the official report from Government has suggested several interventions from policy to practice, advocacy comes into play in all the 14 or so recommendations. However, if we in the advocacy community are to engage meaningfully, then we must ask, what went wrong and what are we not doing right now? This is a key question to given that this has happened when the country had several players implementing programmes dealing with sexual and reproductive health issues for the youth, including family planning.

Some key recommendations from the team which conducted this assessment included raising awareness and promoting use of contraceptives. It was also recommended that special ante-natal and child care services be formulated and provided to teenage girls. A look at the document and its recommendations reveals that there is clear need for advocacy, especially in issues touching on policy and strategy.

Inasmuch as the recommendations look good, as advocates we should be cautious about going in the same direction. In the words of Albert Einstein, “The definition of insanity is doing the same thing over and over again, but expecting different results.”

As early as April 2020, Pakachere Institute of Heath and Development Communication (IHDC), which has a project on advocacy in Blantyre funded by PAI, carried out joint activities with the Blantyre District Youth Officer to lobby for continued outreach to the youth through sexual reproductive health clinics so as to avert teen pregnancies. At that time, the Ministry of Health guidelines were that outreach services should be suspended because of COVID-19. We raised our fears that we would gain on one [the fight against COVID-19] and lose mileage on the other [the fight against teen pregnancies].  We finally rolled out some intensive activities in June and July in almost all Traditional Authority[1] but the damage had already been done. This now challenges us to do some reflecting.

How did we get here?

As a nation, we are reaping the fruits of policy incoherence and inconsistencies couched in religious piety.  There are many instances where we have conflicting policies, or indeed where policy and practice are operating on different levels all because of our religious belief system.

For instance, while the Ministry of Health and its implementing partners are allowed to offer family planning services to everybody in need and provide information to every client, the policy of the Ministry of Education in Malawi is that no contraceptives should be distributed in primary or secondary schools. The idea behind that thinking is that this will lead to immorality. This, it should be said, stems from the fact that more than 61% of primary schools and 33% of secondary schools in Malawi belong to Christian faith-based institutions[2]. In terms of practice, while the Ministry of Health policy on family planning is clear that the facilities and products should be accessible to all, some health facilities which are owned by faith-based institutions are not supportive of that practice. And when it comes to health services, approximately 38% of health services are provided by faith-based institutions[3].

All these facilities derive their core values from the churches which shun contraceptives. Whilst recommending that contraceptives should be promoted is a good thing, we need to have conversations on its implementation on the ground. Even without going into the debate of what these educational and health facilities should start doing or accommodating, we as advocates should be thinking about how we can turn the corner.

Looking at the provision of contraception through the lens of religious affiliations permeates all levels of society in Malawi; including the very basic institution, the family. It is a taboo to discuss contraceptives even if one needs them. Take the recent case where Members of parliament in Malawi returned a donation of condoms all because they said there was reporting that Parliament uses 10,000 condoms per month[4].

 

This brings us to the second issue which is that of cultural norms that guide our behaviour. Although Malawians claim to be free, we still live in a closed society whose culture is responsible for creating misinformation regarding family planning. The findings from the research carried out in 2010 by College of medicine lecturer Effie Chipeta et al still stands 10 years down the line. Her conclusion was that most women and men were not using any modern family planning methods. The reasons cited included family planning methods being perceived as having side effects, such as prolonged menstruation, men’s concerns about impotence and genital sores, weight gain or loss, and subsequent infertility. The research concluded that despite knowing about the different types of family planning methods, and awareness of their ready availability at health facilities, uptake is low because misinformation still prevails. When outreach services were suspended, the teens were at home with parents and guardians who were a source of misinformation.

The third issue is that the advent of COVID-19 forced people and institutions to focus on prevention and management of COVID-19, leaving other health priorities in limbo. We have now woken up to the grim reality that while we are saying COVID-19 is real, teen pregnancies are also real!

New advocacy approaches

As advocates we still have work to do. The question is what next and how? The statistics on teen pregnancies and child marriages are undoubtedly alarming.  As advocates we should appreciate that advocacy is a process that we undertake to ensure that we have better policies, and further, to ensure that there is harmony between policy and practice for the betterment of lives. Most policy changes are made under three conditions: when the issue is economically and politically viable; when there is public pressure and when there is enough evidence.

Do we have enough evidence now indicating that something went wrong? Yes, we do. Do we have enough public pressure for a solution? The answer is yes. Is this issue economically and politically viable now? This is debatable but the time to come together, design new and effective advocacy approaches and speak with one voice is now!

[1] T/As (collections of large areas or villages which form part of a district)

[2] https://acemmalawi.wordpress.com/about/history/

[3] http://www.hanshep.org/resources/shops-country-private-sector-health-assessments/malawi-private-health-sector-assessment

[4] https://www.iol.co.za/news/africa/malawi-mps-irked-by-claim-they-used-10000-condoms-90d1950e-5e3c-5b8e-9ac0-919a6edc46fe

 

Jonathan Mbuna is a Social Development Practitioner who is currently working with Pakachere Institute for Health and Development as Advocacy and Training Manager. He has mainly done his work with NGOs and his main focus has been in areas of health, livelihood, food security, education and gender. In health key issues that Jonathan has championed and been passionate about are around malaria, sexual reproductive health, family planning and palliative care. Born 52 years ago, Jonathan holds masters degree in Public Administration and Bachelors Degree in Social Sciences. Before settling down in the NGO sector, Jonathan worked with Ministry of Health in planning and health administration and also lectured at Malawi Institute of Management.

In his free time, Jonathan like creative writing and has written for several news outlets, published two books both of which won national awards including the Peer Gynt Award. He also used to contribute to BBC radio slots in early 90’s and used to blog for column Spaceforgrace. In addition to being a Social Development Practitioner Jonathan is also a Management Development Consultant and has helped develop capacity of numerous organisations.