Who is Responsible for the Maternal Health of Young People?

This is the question at the centre of the first ever Science Policy Café held at Crossroads Hotel on Thursday, 5 February, 2015 under the theme usage of contraceptives among young people.

Who is accountable for the young woman dying during childbirth in a rural hospital in Edingeni, Mzimba? For the woman in a health center in Mayani in Dedza? For the young mother in a rural home in Malombe in Mangochi? A girl child raped while coming from school, elsewhere in Chididi, Nsanje? Who is accountable for the women and adolescent girls in a thousand places elsewhere in Malawi?

The African Institute for Development Policy (AFIDEP) in collaboration with the College of Medicine, Malawi, ECSA-Health Community, FHI 360, and Ministry of Health (MoH) is implementing a programme on strengthening capacity for data and research evidence use in health sector decision making in Malawi-SECURE- Health. The project is funded by the UK Department for International Development (DFID).

During discussions, it was clear that delegates felt that the burden of ensuring safe delivery does not fall solely on the shoulders of health workers alone, but falls on all of us. Whether we are policy makers, service providers, development workers, husbands, fathers or mothers-in-law, community leaders, we can all make a difference. It is our responsibility to do so. 

As a society, we owe it to young women to ensure they have a safe delivery as well as access to family planning information and services.

Complications from pregnancy and childbirth are the leading cause of death among women and female adolescents in their reproductive years in low- and middle-income countries, Malawi inclusive.

Adolescent pregnancies comprise 26% of all births in Malawi and account for 20% of the maternal mortality rate.  Cultural structures, family as well as the health system, fail many women and girls especially those living in rural and hard-to-reach regions.

These factors—in addition to ill-equipped clinics, attitude of health workers, poorly trained health workers and cultural perceptions about sex and sexuality—contribute to the high teen pregnancies and maternal mortality rates in our country.

We have the responsibility to hold policy makers accountable for reforming health systems in pursuit of universal health coverage (UHC), which will transform populations’ health and save women’s and children’s lives.

retorted, Mr Mbendera of FPAM, one of the panelists.He further says, UHC shifts the burden of health costs from women to society and in a small way, shows our gratitude to women for giving life.

UHC recognizes that women should not be neglected or die while giving life. The responsibility of caring for women during delivery is a societal debt paid partly by eliminating the obstacles to safe, skilled and respectful care during childbirth.

Another interesting angle during the discussion was how the Ministry of Health kept on blaming the Ministry of Education (MoEST) for refusing its institutions to provide contraceptives especially condoms and emergency pills.

Mr Charles Mazinga, Director of School Health and Nutrition in the MoEST, again shifted the blame to Ministry of Gender arguing that, the communities should be the ones to provide this service because the mandate of his ministry is imparting knowledge and skills not providing services.

Dr Kathyola from MoH Research Unit, summarized that family planning should be non-negotiable and included in even the most prudent UHC plans. Everyone has the right to access family planning services, which include the ability to choose when and how to utilize a variety of options.

Through UHC, health systems can be strengthened to ensure that frontline health workers are in the right place at the right time to deliver the right services effectively.

Who is accountable then? For sure we all are. However, living policies that are well coordinated among government departments should provide a pathway for women and girls health well-being in the post-2015 era.

We must embrace this responsibility to accompany, support and empower women and adolescent girls on this journey fraught with both barriers and possibilities.

This forum proved to be very important and the presence of technocrats from key ministries concerned with the topic was a plus to the approach.

Conspicuously missing though was a representative of the local government (Councilor) and the National Assembly since the discussion was to do with policies at local and national level.

Delegates to the café were drawn from the civil society organizations including PACHI,  FPAM, BLM, PSI, DFID, WHO, FAWEMA, SAVE the Children, WFP, UNFPA and others, government departments like the Ministries of Education, Youth and Health and government departments like RHU and Economic and Development Planning.

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