ACCESS to modern contraception still remains a challenge in Zambia for women who live in hard-to-reach places.
For the women in remote areas, access to clinics or health care providers offering contraceptive options is often not easy and in most instances, they opt to stay away.
According to the World Health Organisation (WHO), an estimated 222 million women and girls worldwide want to prevent unintended pregnancy but are not using modern contraception.
It is a known fact globally that delaying motherhood, spacing births, preventing unintended pregnancies, and avoiding unsafely performed abortions is directly proportional to the reduction of maternal mortality.
While lack of accurate information about family planning methods and objections from partners on the part of contraception users have been at the core of inhibiting progress in Zambia with regards to attaining various reproductive health benchmarks, there has been a strong desire amongst the women on the need for a contraceptive method that can be easily given in low-resource, and non-clinic settings.
At the moment, there are three main types of contraception methods namely, short term which include Condoms, oral contraceptives, injectables, long term techniques such as IUCD and Implants (Jadelle), and permanent methods like bilateral tubal ligation, and vasectomy.
However, the use of Depo-Provera, the most popular progestin-only injectable contraceptive is increasing rapidly around the globe and Zambia in particular, on grounds that it is safe and highly effective in preventing unwanted pregnancy.
Depo-Provera can be provided in different settings by a wide range of providers with community health workers playing an increasingly important role in offering this method.
Household delivery of family planning methods are provided in a friendly, comfortable and private setting.
About 179 countries across the world are implementing the provision of Depo-Provera method through Community Based Distributers (CBDs) to reach out to the new family planning users especially among women in rural areas where contraception use is low.
In 2009, a pilot project was carried out in Mumbwa and Luangwa districts by Family Health International (FHI360) in partnership with ChildFund Zambia to ascertain whether the provision of Depo-Provera by CBDs can work for Zambia.
After the research, it was discovered that Community Based Distribution of injectable Depo-Provera was safe, feasible and acceptable among communities in Mumbwa and Luangwa districts.
From the experience in the two districts where a trial project was successfully undertaken, Government through the Ministry of Health is rolling out the CBD provision of Depo-Provera to other parts of the country.
Recently, family planning service providers comprising nurses from Lusaka and Copperbelt provinces, convened in Kabwe to learn the skills of training CBDs in administering Depo-Provera contraceptive method.
Derrick Musonda, who was one of the facilitators during this training of trainers workshop, pointed out that Depo-Provera can be used freely by women of reproductive age who desire an effective, reversible, and long-acting method to prevent pregnancy.
Mr Musonda explained the eligibility of Depo-Provera use, “Women who can use Depo include those that may be breastfeeding babies older than six weeks, those that have no children.”
“It can be used by a woman who wants to space her next pregnancy, or has all the children she desires but does not want permanent contraception and cannot or does not want to use other methods such as those containing estrogen,”
He said women with sexually transmitted infections, including HIV or those on medications such as antiretroviral (ARV) drugs or drugs to treat other infections such as TB are also eligible to use the Depo-Provera method.
Mr Musonda said while Depo-Provera is safe for the majority of women, a small number of women with certain characteristics or medical conditions must not use this option.
“Depo is not recommended for women who are breastfeeding a baby less than six weeks old, women experiencing abnormal vaginal bleeding that may indicate a serious condition; or have severe hypertension with blood pressure of 160/100 mm Hg or higher.”
“Others who are not eligible for this contraception method include breast cancer patients and those that have been treated for breast cancer in the past, women with complicated diabetes, malignant liver tumors, or those that have had a heart attack, stroke or have blood clots,” he said.
As is always the case in various communities, the use of Depo is not without myths and misconceptions as some women believe that it causes cancer of the uterus, infertility, and interferes with breastfeeding.
However, Mr Musonda dispelled the myths by stating that, “In fact, it has been shown that Depo protects against cancer of the lining of the uterus, also known as endometrial cancer. Although it may take an average of nine to ten months for a woman to become pregnant after her last Depo injection, Depo does not cause a woman to become permanently infertile.”
“Depo does not cause abortion. Research on progestin-only injectables finds that they do not disrupt an existing pregnancy. Some women may erroneously believe that if they do not have monthly bleeding they are either pregnant or that menstrual blood is collecting in their bodies. Depo causes the lining of the uterus to become thin and over time many women stop having menstrual bleeding,” he said.
It must be understood that in as much Depo is an efficient method to prevent unwanted pregnancy; the drug does not protect users from contracting STIs and HIV.
CBDs are volunteers drawn from the rural communities where they are already known and trusted, and are trained by health service providers to offer family planning services to women who have difficulties in accessing clinics or health posts.
Empowering CBDs with the responsibility of providing Depo-Provera contraception which is given once every three months, will work a great deal in reducing unwanted pregnancy, which will in turn lead to a drop in maternal deaths and unsafe abortions.
With proper training and support, CBD provision of injectable Depo-Provera, will also address some gaps in the provision of contraception in the rural parts of the country.
For comments, email moseschimfwembe@gmail.com /0955484702
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TIMES OF ZAMBIA, Monday, October 24, 2016
Ministries scale up adolescent sexual reproductive health
DESPITE the fact that adolescent sexual and reproductive health is receiving more consideration at national level, there are still major cracks in both knowledge and plans of action to deal with if Zambia is to attain local and global targets.
One of the major setbacks that continue to deprive young people of their dreams and future aspirations and further robs the nation of future human resources, is the plague of teenage pregnancy.
According to the 2014 Zambia Demographic Health Survey (ZDHS), teenage pregnancy stood at 28 per cent while 28.5 percent of the adolescents (aged betweens 10 and 19 years) in the country, have either given birth or are currently pregnant.
Zambia’s population is predominantly young with adolescents accouting for 27 per cent while 17 per cent of young people are aged between 15 and 24 years as of the last Census, however, the ZDHS revealed that 89.4 per cent of the sexually active married and unmarried adolescents are not using any contraceptive method giving rise to teenage pregnancies and other health risks.
With this evidence clearly highlighting the threats adolescents are facing, addressing the health and development issues of youths, need a rigorous and holistic approach. Therefore, in recognising the importance of young people in the growth and well-being of the nation, the Government and various stakeholders have doubled efforts in ensuring the life of an adolescent Zambian is preserved for a better tomorrow.
In this vein, an inter-ministerial committee comprising five ministries that directly deal with the welfare of young people, has combined efforts in eradicating child marriages, teenage pregnancies, and increasing access to reproductive health services among other critical issues.
The inter-ministerial committee consisting of the ministry of health, ministry of general education, ministry of youth and sport, ministry of chiefs and traditional affairs as well as the ministry of community development, mother and child health, recently convened at Kitwe’s Edinburgh Hotel with a view to operationalise its national programmes at district level.
This particular meeting that was attended by cooperating partners, technical working groups and other stakeholders also delved into the activities of each of the five ministries and policy responses to the plight of adolescents.
In her presentation, ministry of health deputy director mother health, Mary Nambao pointed out that the age of consent which has not been harmonised in different policies and guidelines posed a serious challenge in as far as access to services especially contraceptives for adolescents is concerned.
In Zambia, the Penal code provides for 16 years as the age of consent for sexual intercourse while 21 years is a legally binding age for marriage as enshrined in the Marriage Act Cap 50.
The reality on the ground, however, is different, as the country has recorded a number of teenage pregnancies involving girls as young as 12 years old, contrary to the provisions of the law that recognises sexual activity at more than 16 years.
A 2014 UNESCO report indicated that the median age at first sexual intercourse for females in Zambia is 14 years while that of males is 15 years, and that among the 15 year olds in school, 12 per cent of girls, and 22 per cent of boys have had sex.
Dr Nambao’s point on the age of consent was in line with the daily challenges that service providers are faced with.
“The age of consent makes it especially difficult when the adolescents come seeking reproductive care services. We are torn apart by the adolescent’s wish, what the parents want and what we are required to do, in the end we counsel and educate them (adolescents) on the importance of contraception, family planning and safe sex and try not to exceed our limits,” says dr Mwamba Simutowe of Ndola Central Hospital.
Youth-friendly health services are a key strategy for improving reproductive health services amongst Adolescents; however, Dr Nambao explained that, “We have inadequate functional community adolescent and youth friendly sites in the country.”
“Not all provinces have Adolescent Health Focal point persons at Provincial and District levels. There is also inadequate adolescent disaggregated data such as condom use and contraceptive use,” she added.
To avert some of these challenges, Dr Nambao said her ministry was engaging and coordinating partners through the Adolescent Health Technical Working Group (ADH-TWG) to scale-up youth and adolescent friendly health services (ADHFS) nationally with adherence to standards and guidelines.
“We also provide technical support and conduct training of trainers in adolescent health for health workers and peer educators. Other plans include, providing a core package of comprehensive sexuality education and sexual reproductive health services and operationalising adolescent health communication strategy.” She said.
Child marriage is largely a rural phenomenon in Zambia and the role the ministry of chiefs and traditional affairs plays in implementing programmes to end the vice and to promote adolescent sexual reproductive health cannot go unnoticed.
Chileshe Kasoma, the focal point person on ending child marriage at the ministry of chiefs and traditional affairs said during the workshop that the ministry has made tremendous progress in safeguarding the welfare of teenagers since the launch of a programme on ending child marriage in 2013.
“The programme received tremendous support from both government and international partnerships. In 2015, government engaged traditional leaders as agents of change and 1000 girls were retrieved from early marriages and sent back to school,” Ms Kasoma said.
However, there is need for law reforms in the development of the Marriage Bill proposed to harmonise marriage related legislation, harmonise the minimum age of marriage with international standards,
complement statutory, religious and customary marriages as well as provide for free and informed consent to marriage by both parties.
Doing so will exert momentum to efforts aimed at ending child marriages in the country.
The ministry of gender has recognised the fact that girls are still treated as second-class citizens of this world and are almost completely ignored and that they lack status, protection and prospects in most families and communities.
Assistant director for gender rights protection
Namatama Chinyama said there is need to prioritise adolescent girls.
Ms Chinyama noted that establishing an end to child marriage, will help redress injustices faced by millions of girls each year, accelerate progress toward a range of critical issues, such as universal education, sexual and reproductive health and rights, reduction of poverty and hunger, eradication of gender-based violence, and greater equality between women, men, boys and girls.
“Child marriage is not inevitable. We have the information and the tools to support girls and their families and communities to end the practice. Doing so will change the world for the better for millions of girls, their families and their communities,” she said.
The ministry of youth and sport has taken up the mantle to provide comprehensive sexuality education (CSE) to the ‘out of school youths’ (any person aged 10 to 35 years who may not have attended any formal education, may have dropped out of school before completing that level of education).
A number of partners such as community caregivers, traditional and community leaders, religious and civic leader, peer educators and community facilitators among others are being targeted to roll out this programme.
In all these efforts, the ministry of general education is a critical component in ending teenage pregnancies and provision of comprehensive sexuality education.
As part of its contributions to the common goal, the ministry rolled out a revised comprehensive sexuality education curriculum to all the schools in 2014 which focuses on sexual behaviour and sexual and reproductive health, relationships, values, attitudes and skills, culture, society and human rights, and human development.
The aim of sexuality education programs ultimately is to empower young people to adopt and sustain positive and protective sexual practices.
At the end of the indaba, it was resolved that inter-ministerial committees be constituted at district level in order to implement programmes initiated at national level.
The meeting also called for the need to track budget lines for each of the five ministries with regard to adolescent health interventions.
To sum, the formation of the inter-ministerial committee is a step in the right direction. It is expected that the country will make headways in meeting various policy documents that include the adolescent Health communication strategy, reproductive health policy, national strategy on ending child marriage (2015 – 2020) and the national plan of action on ending child marriage in Zambia (2016-2021).
Happy 52nd Independence anniversary to mother Zambia!
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TIMES OF ZAMBIA, Monday, October 31, 2016
CBDs crucial in family planning
THE provision of family planning services comes with a number of health and socio-economic benefits to the people; hence governments worldwide, Zambia inclusive, have scaled up activities to reach out to every citizen.
However, the challenge of unmet need for family planning services and unwanted pregnancies remain high in the rural parts of Zambia.
With the global village currently pursuing the Sustainable Development Goals (SDGs 2016-2030), family planning is at the core in the attainment of all the 17 universal targets by the year 2030.
In the midst of this indisputable fact, capturing the rural population in family planning programmes is of great importance to the Government and various stakeholders that are committed to fulfill people’s contraceptive needs.
Therefore, the role of Community Based Distributors (CBDs) in delivering sexual and reproductive health services to the rural communities cannot be underestimated.
CBD is a strategy designed by the World Health organisation (WHO) to provide health services directly to members of the community through trained non-professional members (usually as volunteers) of the same community.
Since inception, CBDs have played a pivotal function in providing information and temporary contraceptive methods among others, the pill, condoms, as well as other primary health care services to the far flung areas that in the past saw little attention.
In 2015, the USAID funded a sexual and reproductive health for all initiative (SARAI) project which incorporated CBDs among other players to increase access to family planning information and services in 15 districts of Luapula, Muchinga and Copperbelt provinces with the aim of reaching out to 400, 000 people.
On the Copperbelt, the CBDs have so far achieved a milestone in delivering sexual and reproductive health services in the targeted catchment areas of Chililabombwe, Chingola, Ndola, Kitwe, Kalulushi, and Mufulira districts.
The Copperbelt has since posted an upward trend in service delivery points hence recording a rise in the accessibility of family planning commodities as confirmed by provincial medical officer Consity Mwale in a press query.
“The increase has been demonstrated by an upward trend in terms of clients reached. For instance, Condoms uptake in 2013 was 1,215,810, 2015 uptake increased to 1,270,748. For oral contraceptives in 2013 uptake was 92,657 and in 2015 uptake increased to 122, 334,” says Dr Mwale.
He says CBDs’ provision of Depo Provera (DMPA) is acceptable and expands access to family planning methods in the rural districts of the province.
“About 35 per cent of the women who received an injectable contraceptive method reported that their first DMPA injection was their first use of a family planning method.”
“So far results indicate that CBD agents can safely provide injectable contraceptives although some programmatic aspects of the pilot program need to be strengthened. The CBD have been trained and have mentors and supervisors who are qualified health workers,” he said.
One of the major setbacks in the provision of family planning services in Zambia has been the dominance of males in decision making between married couples on the use of contraceptives and in most cases end up in disagreement.
Chibale Ndashe of Mukolwe area in Ndola district appreciates the role CBDs have played in changing his perception over the use of contraceptives as a way of spacing his children and the involvement of men.
“We used to have disputes with my wife whenever she brought up the issue of contraceptives because I did not understand the importance of family planning. But since I attended an awareness programme that was being spearheaded by volunteers (CBDs) in our community, I learnt a lot and what child spacing can do in my family.”
“Now I am able to sit down with my wife and discuss issues of family planning freely without any disagreements,” he said.
Mr Ndashe’s story is testimony enough of the impact CBDs are making in changing mindsets in the rural community.
In line with the Government’s pronouncement that ‘no woman should die while giving birth,’ the Copperbelt provincial medical office has invested in infrastructure development, human resource capacity development, transport, provision of medical and surgical supplies and community involvement.
Dr Mwale says, “We are encouraging women to attend antenatal four times during each pregnancy and to deliver in health facilities. Safe mother hood action groups (SMAGS) have been assisting in creating demand for maternal services and identified clients with risk pregnancies are admitted early to mothers’ shelters in places where these exist.”
Planned Parenthood Association of Zambia (PPAZ) Chingola district chairperson Ngosa Chime is of the view that these volunteers must be empowered financially to allow them carryout their responsibilities with diligence.
Mr Chime has also appealed to the inter ministerial committee to beef up personnel in Chingola by engaging district program coordinator, monitoring and evaluation officer, data entry officer under the ministry of community development and ministry of youths to work hand in hand with the district medical team, CBDs, and non-governmental within the district.
The current situation in Chingola is that the use of contraceptives among the youths aged between 18 and 24 years has swelled while teenage pregnancy dropped to 716 in 2014 from 771 recorded in 2013.
“Low use for contraceptives previously was as a result of lack of information to some people especially those in peri-urban and young people, but with the information we are giving on the ground, young people have started realising the importance of doing right things at the right time and place.”
“The demand for contraceptives has increased among those aged between 18 and 24 years has increased to 1, 236 with methods such as pills, injectables and condoms by both males and females,” he said.
Meanwhile, PPAZ has initiated project dubbed ‘Positive action for young women and girls’ aimed at promoting sexual and reproductive health with the ultimate target of reaching out to 90 per cent of youths across Chingola by the year 2020.
“The ‘positive action for young women and girls’ project, which will be starting likely early December 2016, will see us reach every corner of the district. We have volunteers in schools, markets, churches, and will be carrying out door-to-door education to people,” he said.
With massive support to the CBDs strategy in providing sexual and reproductive health, Zambia will meet its targets.
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TIMES OF ZAMBIA , Monday, November 7, 2016
Scale up youth friendly health sites
THE setting up of adolescent and youth friendly health sites in the country is one of the significant strategies aimed at increasing access to sexual reproductive health services by the young people.
With enthusiastic young volunteers, these sites are tailor-made to attend to the reproductive health needs of adolescents and young people, providing services such as counseling, comprehensive sexual education, and contraception.
In its 2011 Plan of Action, the ministry of health set out on a mission to increase access to family planning services and delivery of adolescent and youth friendly reproductive health services across the country.
The idea behind the friendly health sites strategy that was initiated globally in 1992 is to create a conducive environment, where young people would freely access reproductive health services without any form of stigma, prejudice, and be at ease to discuss issues with a service provider.
In contrast, it is a known fact that most adolescents and youths in the country today decline to seek reproductive health services at a clinic or hospital set up where in most cases, privacy is not guaranteed.
Adequate space is one of the standards for service provision identified by the ministry of health in its national standards and guidelines aimed at strengthening adolescent friendly health services in the country.
However, the situation on the ground proves otherwise as a survey carried out by this author in Ndola last week on the availability of conducive adolescent and youth friendly health sites revealed some gaps in the system.
Most government run clinics have little space reserved for adolescent reproductive friendly health service and equipped with trained staff, various commodities, information, education communication and supplies, and equipment required.
The scenario entails that young people that seek reproductive health services are left with no choice but to queue up with other people seeking medical care.
For fear of embarrassment and prejudice of being seen at a clinic, adolescents and young people opt to stay away from clinics even when such facilities have highly trained service providers who uphold confidentiality.
Ministry of health, mother and child health deputy director Mary Nambao recently pointed out that inadequate functional community adolescent and youth friendly sites across the country, is one of the challenges the ministry is facing in delivering reproductive health services to young people.
This development indeed calls for serious introspection from all stakeholders.
A chat with one of the service providers on condition of anonymity further reaffirmed the need to have facilities best suited for young people friendly health sites.
“There are a lot of adolescents who are scared of coming here (clinic) to access reproductive health services because they fear meeting people they know.
“We have had situations where some girls would approach us when we are outside the clinic premises and explain what their problems are, which have to do with accessing contraceptives and how uncomfortable they are to be coming to the clinic,” the source said.
Ndola district senior nursing officer for adolescent reproductive health Elizabeth Ng’ambi also explained that inadequate space has been hampering the smooth delivery of services to the intended beneficiaries.
Ms Ng’ambi said, “If we were going to have separate rooms where we can administer reproductive health services to the adolescents, it would make them feel comfortable because currently, they have to line up with the rest of people seeking other services.”
Marie Stopes Zambia country director Peter Schaffler noted that there was need for the adolescent and youth friendly site to be an environment where young people should feel comfortable when seeking services.
Mr Schaffler said establishing youth friendly sites separate from clinics or health posts would be ideal to encourage more adolescents and young people to access reproductive health services in the country.
Marie Stopes Zambia is currently rendering technical support in the area of adolescent and reproductive health to the Millennium Development Goal Initiative (MDGi), a joint programme of the Zambian Government, European Union (EU) and the United Nations (UN) that aims at improving the availability and quality of reproductive, maternal newborn and child health and nutrition services in the 11 targeted districts.
Under the MDGi programme, Marie Stopes will be offering technical support in establishing integrated sexual and reproductive health, including HIV prevention through the creation of adolescent and youth friendly sites in health clinics and communities.
“There is no model on how the adolescent and youth friendly site should be set up but I think it should be something that young people would be comfortable with. The sites need to be separate from health posts.
“In situations where the sites are within the clinics, it would be appropriate to create a different entrance from the rest to allow young people feel free as they access reproductive health services,” Mr Schaffler said.
He said Marie Stopes would require the actual involvement of adolescents in the design and how the friendly sites should be set up in conformity with what constitutes a conducive environment for young people.
Centre for Reproductive Health and Education executive director Amos Mwale has added his voice on the topic saying the concept of the friendly sites is non-existent in Zambia owing to the fact that services are offered under the normal health structures.
Mr Mwale explained that a typical youth friendly site must provide a free atmosphere for young people to freely access the services without suffering any form of judgment based on race, religious faith or cultural beliefs.
“In most instances service providers have been a big challenge because of their judgmental attitudes in service delivery which calls for continuous training. We also need to have groups similar to CBOs in the provision of youth friendly health services in order to reach out to all young people,” he said.
On a positive note, the Ndola City Council (NCC) has stepped in to donate two community halls in Twapia and Lubuto townships for use as friendly health sites while the Kitwe local authority through senior community development officer Innocent Kayafa has pledged to emulate their Ndola counterparts.
All in all, the non availability of private space in health institutions and communities has been an obstacle in accessing reproductive health services by young people under the friendly health sites strategy.
But with combined efforts from stakeholders, who include local authorities in implementing the strategy, more adolescents and youths are poised to access the services, a move that could significantly reduce unwanted pregnancies, and sexually transmitted infections (STIs) amongst the young cohort.
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TIMES OF ZAMBIA, Monday, November 14, 2016
Safe motherhood gets more attention
THE dawn of safe motherhood initiative in 1987, signaled increasing global attention to reproductive health with governments committing finances towards safeguarding the health of mothers and infants.
According to the World Health Organisation (WHO), the maternal mortality ratio (MMR) from 1990 to 2013 declined by 45 per cent, from 380 deaths to 210 per 100, 000 live births which translated into an annual rate of 2.6 per cent.
Ensuring that all women receive the care they need to be safe and healthy throughout pregnancy and childbirth is what underscores the significance of safe motherhood.
It is worth noting that the goal of safe motherhood initiative to which Zambia is a signatory, is to reduce the number of women dying from preventable complications during childbirth and improve survival among children under five years of age.
Maternal deaths in Zambia account for 10 per cent of all deaths among women aged 15 to 49 years as revealed by the 2013/2014 Zambia demographic health survey (ZDHS).
However, the Zambian government through the ministry of health has declared that, ‘no woman should die while giving birth,’ and has followed up this statement with a number of interventions in collaboration with various key stakeholders.
This pronouncement has seen the construction of more health posts across the country to ensure increased access to reproductive health services, improvement of the road network in the remotest parts of the country so that expectant mothers do not delay in seeking medical care, and taking basic medical care to people’s door steps through diverse initiatives such as Community Based Distributors (CBDs).
To this effect, the maternal mortality ratio (MMR) has significantly reduced to 398 deaths per 100,000 live births from 591 in 2007 owing to the fact that a good population of women are now giving birth in health facilities.
Despite Zambia posting this momentous reduction so far, the battle against maternal mortality is still far from being won.
This is so because the factors known to contribute to these preventable maternal deaths which include delay in decision making to seek medical attention, delay in accessing a health facility, and delay in receiving appropriate medical attention at a health facility, are still frustrating the resolute efforts being made.
For instance, the Copperbelt province recorded 53 maternal deaths between January and October, 2016, and out of this figure, four were young mothers aged between 15 and 19 years, accounting for 7.3 per cent of women deaths.
In a bid to avert this situation, Copperbelt provincial medical officer Consity Mwale said, “We have invested in infrastructure development, human resource capacity development, transport, provision of medical and surgical supplies and community involvement.”
“We are encouraging women to attend antenatal four times during each pregnancy and to deliver in health facilities,” Dr Mwale said.
Non-governmental organisations (NGOs) are equally in top gear to ensuring that childbirth is safer for women across the country by promoting women’s health.
One of the these organisations is the Planned Parenthood Association of Zambia (PPAZ) who are leaving no stone unturned in promoting safe motherhood in various parts of the country.
In the transit town of Chingola on the Copperbelt province, PPAZ will be launching a project dubbed ‘Positive action for young women and girls’ before the end of 2016.
The project that will be targeting women aged between 15 and 48 years is aimed at improving access to maternal health in the district with a goal of reaching out to 90 per cent by the year 2020.
PPAZ Chingola chairperson Ngosa Chime said information is key in promoting safe motherhood and once young women and girls are empowered with knowledge, teenage pregnancy and maternal mortality in Zambia will further reduce.
Mr Chime said lack of knowledge on reproductive health posed a serious threat in the country’s efforts to wipe out maternal deaths but that the ‘Positive action for young women and girls’ project will contribute significantly to the national targets.
“We have discovered that lack of information on the importance of sexual reproductive health has playing a part in the increasing levels of teenage and unwanted pregnancies in the district which contributes to maternal deaths.”
“Under the ‘Positive action for young women and girls’ project, we are going to work hand in hand with the district health management team in reaching out to our target group in far flung areas in Chingola,” Mr Chime said.
The organisation has since devised an outreach strategy that will involve visiting schools, churches, drama outreach, and door-to-door sensitisation in spreading information.
“To achieve the 2020 target of reaching out to 90 per cent of women and girls, the district has been divided into four zones. Zone one includes areas like Kasompe, Mimbula and Lulamba while Chikola, Chiwempala, Hellen Community and Mudenda are in zone two.”
“Zone three will have Soweto, Kapisha and part of town centre, and the fourth zone is covering Kabundi east up to Nchanga north. We are determined to reach every corner of the district,” he said.
Marie Stopes Zambia is implementing an emergence response project called ‘Dreams’ aimed at reaching out to girls in Ndola and Chingola, who are the most vulnerable to unwanted pregnancy.
“Marie Stopes is going to establish dreams centres in Ndola and Chingola in the next three months to provide information on sexual reproductive health to girls. The project will be focusing on the vulnerable group,” Marie Stopes country director Peter Schaffler said.
Safe motherhood action groups (SMAGS) in rural districts such as Masaiti, are doing exceptionally well in creating demand for maternal services and ensuring that women with risk pregnancies are admitted early to mothers shelters in places where they (mothers shelters) exist.
The goal of SMAGS is to reduce the number of women dying from preventable complications during childbirth and improve survival among children less than five years of age.
All in all, safe motherhood entails that women must receive high-quality gynecological, family planning, prenatal, delivery and after delivery care, in order to achieve best possible health for the mother, fetus and infant during pregnancy, childbirth and after childbirth.
Women and girls must enjoy the right to life through safe motherhood and it is therefore, crucial that stakeholders reach out to more underserved and hard-to-reach women and girls across the country to provide easy access to quality maternal health, adolescent health, and family planning services.
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TIMES OF ZAMBIA, Monday, November 21, 2016
Luanshya mayor on safeguarding youths
THE local authorities or district councils have a crucial role to play to promote sexual reproductive health and rights (SRHR) for adolescents and safe motherhood across the country.
According to this author’s experience since the inception of this column, the proximity of SRHR advocates to the communities is key in abating the cross cutting issues of teenage and unwanted pregnancy, child marriage and family planning among others.
Currently, Government is implementing the national decentralisation policy through devolution of power which sanctions local authorities with the responsibility to manage their own affairs for efficient and effective delivery of services.
Furthermore, part 11 of the amended Constitution of Zambia under the system of local Government, also spells out the powers vested in district councils to spearhead social economic development activities under their jurisdictions.
Article 151 section one (d) states that, “there is established a local government system where the capacity of local authorities to initiate, plan, manage and execute policies in respect of matters that affect the people within their respective districts is enhanced.”
With this Constitutional endorsement, local authorities must play a huge role in the issue of family planning, a worldwide phenomenon that is directly linked by the global village to the attainment of Sustainable Development Goals (SDGs) by year 2030.
This calls on mayors, who are at the helm of these local authorities and have an extended tenure of office from three to five years, to be proactive in initiating, planning, managing and executing sexual reproductive health programmes to ensure their districts are not left behind in the global push.
Realising the huge task that comes with overseeing the well being of people in the district, Luanshya Mayor Nathan Chanda has vowed to ensure the mining town moves in tandem with the rest of the country in safeguarding the lives of adolescents.
The future prospects of any local authority rest heavily on the well-being of its young people and it is prudent for civic leaders to use their influence in championing the noble cause of reproductive health to preserve the future of adolescents and guarantee a better tomorrow for their districts.
During a conversation with this author at the weekend, the Luanshya mayor rightly pointed out that, “there cannot be a future in the nation if we leave the adolescent sexual and reproductive health matters unattended to.”
This statement did not come as shock but rather, it was an affirmation of a huge task the mayors carry on their shoulders in ensuring residents of their respective districts, have access to quality primary health care.
In one of the previous editions of this column, some stakeholders highlighted the need for adolescent and youth friendly health sites to be established separately from clinics on grounds that young people are not free to visit health facilities to access reproductive health services hence they opt to stay away.
The good news for Luanshya is that the mayor has pledged to address the challenge of space by offering infrastructure for the establishment of adolescent and youth friendly health sites in all catchment areas.
“These youth friendly health sites need to be outside the clinics and some public institutions so that youths can be free to access them. My office will make sure that the local authority helps with the infrastructures for these activities,” he said.
The subject of underage patrons in drinking places has been a thorny issue in many councils for a long time now with youths under the legal age of 18 years constantly patronising bars and night clubs, a trend that has contributes to unwanted pregnancies among the young cohort.
Mr Chanda says the municipal council through the department of environment and housing is enforcing the by-laws to ensure that young people do not fall prey to patronising bars.
“l want to take advantage of this opportunity to warn that we will close down these bars and revoke all their trading license if anyone is found wanting of allowing underage drinking in bars.”
Although safe motherhood is receiving more attention from various stakeholders across the country, there are still some gaps in Luanshya that need to be patched up to ensure quality health care for all.
Despite its vastness that calls for a great deal of thrust to reach out to every woman requiring quality reproductive health care, Luanshya’s far flung areas still remain underserved owing to various constraints, among them, inadequate trained Safe Motherhood Action Groups (SMAGS).
SMAGS are a group of volunteers trained to help sensitise mothers on the importance of delivering at health facilities and also provide reproductive health services in rural communities where they exist.
Alas, Luanshya only has 100 volunteers to service 87 existing zones in the district and Mr Chanda has sent a passionate appeal to stakeholders, “these are not enough at the moment and we need to train more so that each of the 87 zones can have at least four trained SMAGS.”
However, the local authority has been conducting integrated outreach services to all wards to reach peri-urban areas to ensure services are taken to the mothers and children who have difficulties accessing health care at the clinics due to long distances.
The completion of five maternity wards that are currently under construction and rehabilitation at Mpatamatu 26 clinic, section 9 in Roan Township, Mikomfwa urban clinic, Fisenge clinic and Thomson Hospital will ease some of the challenges being faced in delivering safe motherhood.
“Once these are completed, the number of delivery centers will increase in the district with better privacy and equipment. I am happy that the Government is also recruiting and posting new staff to the district which will improve on the staffing level and help reduce the long waiting time mothers spend at clinics. It will also improve on quality of service,” the mayor said.
With the active involvement of civic leaders in championing family planning and reproductive health rights for adolescents, the cases of teenage pregnancy, school dropouts and other social ills that negatively affect young people, will reduce.
Mr Chanda has taken a leading role in spearheading family planning issues by working hand in hand with the Luanshya district medical team; other mayors can emulate this move to ensure the programmes of the inter-ministerial committee are implemented.
Send your comments to moseschimfwembe@gmail.com or 0955484702
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TIMES OF ZAMBIA, Monday, November 28, 2016
Plight of mentally ill pregnant women (Pt 1)
LANGUISHING in streets, sleeping in inhumane conditions, scavenging for food in rubbish bins and struggling with negative attitudes from society are some of the serious challenges that people with mental disorders in Zambia contend with on a daily basis.
In addition to these struggles of very low self-esteem in the eyes of society, mental patients are subjected to various forms of ill-treatments with sexual abuse of the female cohort by unknown perpetrators, widespread.
A mental disability is characterised by serious shifts in mood, energy, thinking, behavior and unsound judgment.
Though not properly documented statistically, it is a familiar sight in a number of communities to find some mentally disturbed women heavily pregnant while others are spotted moving aimlessly in streets with babies on their backs.
This scenario is a clear indication that there has been little or no response to the plight of an expectant woman psychiatric patient in Zambia to ensure that she is protected from all forms of harm in her community, as required by the United Nations Convention on the Rights of Persons with Disabilities which Zambia ratified in 2010.
Today’s subject explores the question: Do the mentally disturbed women in Zambia have access to safe motherhood and contraception?
Albeit a few that may be in mental health institutions, most of the women with mental problems have no fixed abode, cannot take medicines when they fall ill and in fact, when pregnant, they cannot visit the antenatal clinic or go for delivery when the pregnancy is due.
Safe motherhood consists of a series of initiatives, practices, protocols and service delivery guidelines designed to ensure that women receive high-quality gynecological, family planning, prenatal, delivery and after delivery care, in order to achieve optimal health for the mother, foetus and infant during pregnancy, childbirth and after delivery.
However, the significance of safe motherhood in expectant mothers, who suffer from various mental illnesses, is absolutely nonexistent.
According to the UNAIDS, 4000 Zambian women die each year due to complications related to pregnancy or delivery.
The government pronouncement ‘no woman should die while giving birth’ should cater for all women regardless of mental state, religious background, race, creed or status in society
In Chieftainess Malembeka’s chiefdom in Mpongwe, a rural District in the Copperbelt province, the meaning of safe motherhood is at complete variance with the reality on the ground for the pregnant psychiatric patients.
The traditional leader, who is a ‘change champion’ in adolescent and sexual reproductive health, is deeply concerned with the level of mentally disturbed women in the Lamba land who were being impregnated by unknown people and left to carry the burden of pregnancy without proper care.
She aired her concerns during an orientation workshop for ‘change champions’ in Kitwe last week.
“The cases of mentally disturbed women falling pregnant are rife in my chiefdom and it is unfortunate that perpetrators are not known or found. A woman who falls pregnant requires to be going for antenatal clinic, eat proper food for her health and that of an unborn baby but sadly, this is not the case for the mentally ill who move aimlessly from village to village.”
“It would be important to avoid the high risk of maternal mortality for such a group of people if the relevant authority can consider coming up with a programme where long term contraception such as injectables are given to these people to prevent them from going through the pain of carrying the pregnancy,” she said.
Chieftainess Lesa of the same District has endorsed her counterpart’s opinion and further stressed an urgent need to extend reproductive health and family planning services to the mentally disturbed women, who she says are often neglected.
“My chiefdom has not been spared from this unfortunate situation. One of the incidents in my area involved a subject who was constantly impregnated and ended up having seven children with unknown fathers. This matter needs urgent attention,” she said.
The medical view:
University Teaching Hospital (UTH) Consultant Obstetrician Gynecologist Dr Samson Chisele shares his experience in dealing with pregnant psychiatric patients, “In this particular case, this person does not necessarily stay home and sort of loiters in the streets but she had relatives who discovered her pregnancy and they brought her to the hospital.”
“The pregnancy was already advanced, and we were trying to link her to the social welfare department and the Chinama hospital but it was difficult because she sort of declined to go to these facilities and somehow she just got missing and could not be traced.”
Dr Chisele says last case he handled, involved a girl who was about 14 weeks pregnant.
“The guardians came to the hospital so that we could have that pregnancy terminated on grounds that they could not afford looking after her and her pregnancy because they had so many children to look after.”
“When the girl came to the hospital, she was not able to make good judgments, but for some reason, she was able to understand that she was pregnant and not aware of how to take care of the pregnancy but in the end we established whether that child was in the best interest of the guardians and the service they required was offered.”
“ They also asked us if we could give some long term contraceptive to that child so that she could continue going to school, apparently she was going to some school though it was irregular owing to her mental state and so we offered that service,” he said.
The ethical requirement for medical practitioners is that informed consent must be voluntary and devoid of undue inducement and coercion.
Dr Chisele says administering injectable contraceptives to psychiatric women could be a very reasonable option but that it has its own challenges.
“Most contraceptives will have minor symptoms and when people that are mentally sound are counseled about these contraceptives, they are given explanations on what to do in case something happens which may not always be easy for psychiatric patients and so the first problem is follow ups.”
“If one is going to be taking injectable contraceptives, again that’s not likely to be sustainable because two or three months, they still need to come back to the facility so they require someone who needs to bring them back, that’s one of the challenges,” Dr Chisele said.
He says there are some complications that relate to some of the contraceptives such as excessive bleeding which may not be not good for psychiatric patients.
The Doctor explains that a loop which can stay for five or 12 years could be an option but was quick to mention that the decision to administer contraceptives should not be based on a person’s mental state.
“Some of the women we see around that are said to be unsound mentally, have disorders which are not permanently bad, they may be bad at one moment and then the next moment they are better depending on circumstances, and so how do we deal with such people?
“There is need to harness suggestions such as the ones the royal highnesses have put across and in the process try to address some of the existing impediments. The health providers are also afraid of being sued for example by someone who they may think is a lost cause but this is a good suggestion,” he said.
There is need therefore, to look at the mental retarded expectant mothers as a special group of women who need care and support. There may not be easy answers to the question of the mentally disturbed having access to safe motherhood but the most important thing is to keep opinions coming on the best possible solutions.
Look out for the religious and legal positions on this subject in the next edition.
Meanwhile, family planning change champions drawn from communty last week convened in Kitwe under the auspice of Marie Stopes Zambia, to learn various skills of promoting the cross cutting issues of adolescent sexual reproductive health and family planning in their respective communities.
The change champions are individuals from all spheres of life that have engaged and mobilised community members to improve their entire community’s health and well being.
Among the topics covered were, creating awareness about antenatal care services available in the community, when and where they can be found, convincing women that medication given routinely during pregnancy is safe and will not harm the baby as well as educating women, men and youths on the importance of antenatal care, making birth plan and knowing common dangers and complications of pregnancy,
For comments email moseschimfwembe@gmail.com/0955484702
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TIMES OF ZAMBIA , Monday, December 12, 2016
Plight of mentally ill pregnant women (Pt 2)
MENTALLY challenged mothers are a section of vulnerable women within the Zambian communities who live with a mental health disorder and yet bear children often from unknown men.
These women often live on the streets, which makes them more prone to sexual and other forms of abuse.
In Zambia today the current situation on mental health is general as described in the national health policy.
According to the national health policy, mental health problems and mental disorders are a major disease burden within the community that is driven by factors such as family systems, poverty, rising rates of urbanisation, unemployment, alcohol and substance abuse (including tobacco), child abuse, HIV/AIDS, and violence against women.
The policy further indicates that although no comprehensive epidemiological studies have been undertaken to determine the extent of mental illnesses in the Zambian population, it is estimated that 20 to 30 per cent of the general population has mental health problems.
Mental illnesses also represent 19 per cent of the global disease burden and with mental health problems and mental disorders are marginalised, stigmatised, and discriminated against.
It is against this background, that the National Health Policy has taken mental health as a crucial component of primary health care and the overall health service delivery strategy.
The 20 to 30 cited in the national health policy of the affected population includes women who live on the streets suffer not just from mental disorders but are sexually abused and bear children.
Albeit a few that may be in mental health institutions, most of the women with mental problems have no fixed abode, cannot take medicines when they fall ill and in fact, they cannot visit the antenatal clinic or go for delivery when the pregnancy is due.
In part one of this topic, we highlighted how Chieftainesses Malembeka and Lesa of the Lamba people of Masaiti and Mpongwe districts in the Copperbelt are infuriated at the rate of mentally ill women falling pregnant in their chiefdoms every year, and no one cares about it.
The two traditional leaders proposed that there should be a deliberate policy to ensure that long-term contraceptives are administered to mentally ill women as a way of protecting them from the risk of maternal mortality and also the burden of being pregnant.
However, the ethical requirement for medical practitioners is that informed consent must be voluntary and devoid of undue inducement and coercion.
Consultant obstetrician gynecologist at the University Teaching Hospital (UTH) Samson Chisele pointed out that taking into account the fact that some mental health conditions are not permanent, administering of long-term contraceptives on mentally ill women in the absence of informed consent, could raise legal repercussions.
Where the Civil Society Organisations (CSOs), the church, community leaders, and families to stand up against the sexual abuse of the mentally challenged women in the communities?
Whereas Government can provide a specific legal frame work to protect these vulnerable women, traditional leaders, and families may call for long-term contraception for these victims, what is the role of the church all this?
From my inbox, Evangelical Church in Zambia Reverend Allan Kasungami provides insight into the religious about the plight of mentally ill pregnant women in response to part one of this topic.
“The teachings of the Bible are clear that each one of us is created in the image of God regardless of our physical, social, economic, psychological and cultural state (Genesis 1:27). This guarantees ones’ human worth and sanctity to enjoy all rights and privileges of life.”
“In the teachings of the Bible, we read how Jesus Christ dealt with the marginalised and the powerless in his time. He ate with the rejected of society called sinners indicating that everyone is worth it before God no matter what or who we are.”
“Jesus further healed a man, who by description can be said to have had a mental condition and lived in the tombs, walked about naked, had extreme physical power that he would break chairs. When Jesus met him he did not chase him away or pour scorn on him, instead Jesus dealt with the demon and the man was made whole,” Rev Kasungami states.
He cited the book of Luke 8:35 which reads, “And the people went out to see what had happened. When they came to Jesus, they found the man from whom the demons had gone out, sitting at Jesus’ feet, dressed and in his right mind; and they were afraid.”
The clergyman says the church must begin to teach the true value of humanity to abate cases of mentally ill women being impregnated by ‘heartless’ men.
“There are two important truths that our societies must understand. First, mental disorder is a disease just like any other and therefore does not make those who suffer from it less human. Second, there is need for us to bring healing and care for the mentally challenged just as Jesus did.”
“Sexually abusing a mentally challenged woman or any other person because of their disability is to dishonor God who has created them,” he said.
Rev Kasungami has proposed that in order to safe guard the worth and dignity of such woman, perpetrators must be dealt with by a strong and specific legal framework because the Government has a God given mandate to protect the oppressed.
He says, “It’s known that perpetrators are often men who mix wealth with witchcraft as advised by ritualists who believe having sex with a mentally challenged woman makes one rich. The said ritualists must be held as accomplices to this vice.”
On the provision of long-term contraceptives, Rev Kasungami says the premise for this intervention to prevent pregnancy so as to protect the lives of sexually abused women from the dangers of pregnancy complications and further spare the lives of innocent children born in these unfortunate circumstances.
He says providing contraceptives will not stop the sexual abuse but that the stakeholders’ goal must be to protect the dignity of the mentally ill women by dealing with perpetrators.
Rev Kasungami also suggests that an effective study should be conducted in Zambia by experts and avail the information to stakeholders for further action.
“The mentally challenged women who fall pregnant must be withdrawn from the streets to live in safe houses where they can receive maternal health care, long-term contraception must also be provided, and care for children born in these unfortunate circumstances should be priority so that they don’t end up on the street,” he said.
From the clergyman’s narrative, it is clear that the responsibility of caring for the mentally ill women, who fall pregnant while living on the streets, rests on everyone.
The church is in support of interventions that will restore the dignity of these women, including the provision of contraceptives but most importantly, bringing perpetrators to book.
It is therefore important for all stakeholders to devise mechanisms that will ensure this special group of women, have access to shelter, clean water and food as well as quality health care services.
For comments, email moseschimfwembe@gmail.com/0955484702
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