ReliefWeb

14 DEC 2012 00:00 - FARANAAZ PARKER

The country is focusing on giving women access to family planning services. Faranaaz Parker reports.

On a grey Wednesday morning in the Malawian capital of Lilongwe, a group of young people performs a skit for philanthropist Melinda Gates, who has come to visit their recreational centre. It is a draughty room with wooden board walls and sheets of corrugated iron roofing that do not quite meet.

In the skit, a persistent teenage boy tries to pressure his unwilling girlfriend into having sex. "If you want to have sex, we're using this," she says, pulling a condom out of her back pocket.

The boy is affronted and bellows excuses. "Okay, if you don't want that, maybe this one," says the girl, pulling a female condom from another pocket.

There are titters of laughter from the teenagers, who are all members of the Lilongwe Youth Action Movement, a part of the Family Planning Association of Malawi. Gates is as amused as they are.

"I've seen a lot of dramatisations over the years out in villages. I've never seen anybody dramatise a woman trying to negotiate a condom with her partner," she said later on. "They did a great job with that."

The group's message is desperately needed in Malawi, where many young people become sexually active in their early teens. Girls often marry young and will have had six or seven children by their 20s.

Family planning back on the global agenda

At the clinic in Lilongwe, the women queuing for family planning services, many of them with babies strapped to their backs in traditional cotton slings, are still in the full bloom of youth. The legal age for marriage in Malawi is 16 and there is a growing lobby pushing for it to be increased to 18. But without buy-in from communities, there is no telling whether the law will be passed.

Gates's visit to Malawi comes at a time when the Bill & Melinda Gates Foundation is putting family planning back on the global agenda. This year the organisation, with the United Kingdom's international development department, secured $2.6-billion in pledges for family planning. It hopes to expand this service to 120million women who would like to use contraception but do not have access to it, which could save 200 000 lives and prevent 100-million unwanted pregnancies.

Analyses have shown that every dollar spent on family planning saves $6 on development in other areas such as health, housing and water, making it a smart investment.

More surprising is how quickly it can have an impact: Gates said it now took just one generation for family planning to take root.

"[Malawi] should see very quickly the start of a change in the next generation for women, which means women will stay in school longer [and] have more economic benefit from that, which we know ploughs back into the family."

Gates has frequently called for women to be at the "centre of the issue" by being educated about contraceptives and having access to them. "Those two things will change things. It means girls can stay in school [and] go all the way through secondary school, so at the other end they have a different trajectory for economic output for themselves and for their families," she said.

Fierce proponent

This week Gates met with Malawian President Joyce Banda and tribal chiefs to discuss a partnership in programmes to improve family planning and rural development.

Banda, an ally in the pursuit of safe motherhood, is a fierce proponent of maternal and child healthcare. Her passion is driven by deeply personal experiences: a childhood friend, denied the opportunity to study after high school, married at 18, had eight children and still lives in the same village where they spent their youth. As an adult, Banda resisted cultural expectations and left her abusive husband after years of marriage. Later, she almost died from complications arising from her pregnancy with her fourth child.

Her experiences are common in Malawi, where many young girls never finish school and have poor prospects for economic empowerment, little equality in their relationships and little hope of negotiating the use of contraception.

But Malawi is working hard to change this, embracing novel strategies suited to the local context.

In April Banda launched a presidential initiative on maternal health, which has focused on training midwives, building shelters for pregnant women who may need care far from home and mobilising chiefs and ­various communities.

The country also wants to provide patients with integrated health services that offer family planning, cervical cancer screening, voluntary counselling and testing for HIV and treatment for sexually transmitted infections all under the same roof.