Access to public health services, a right for all

Access to sexual and reproductive health services is still a challenge among other adolescent girls and young women (AGYW), especially in the rural communities of Malawi. This is due to several reasons including unavailability of the services within walkable distance, lack of awareness on the availability of the services, but also the belief that these services are only eligible for married women.

This poses short and long-term challenges to the AGYW and the nation at large. Early and unwanted pregnancies, for example, are some of the short-term challenges that put the girls at high risk of maternal deaths. United Nations Population Fund (2013) report stipulates that stigma, rejection and violence by partners, parents and peers is common among unmarried pregnant adolescents. Still more, adolescent age is a school-going age which implies that if impregnated, a girl’s education is affected despite the chance of going back to school again after delivering the child. In the long term, these challenges affect the health, social and economic costs of the country for the unplanned births and maternal deaths that can be prevented.

These challenges call for a unified effort to protect the AGYW from contracting sexually transmitted diseases, unwanted pregnancies and most specially to allow them to realize their right to sexual and reproductive health services.

ActionAid Malawi is one of the organizations that are implementing activities aimed at promoting AGYW’ access to sexual and reproductive health services. Under its Joint TB/HIV Joint Global Fund Programme, ActionAid Malawi is implementing an AGYW Module that among other things, ensures that AGYW are reached with HIV prevention programs that have a full defined package of services. These services include, HIV & AIDS information, sexual reproductive health (SRH) services, life skills, gender-based violence (GBV) screening and referral to support other services.

Through this program, AGYW from the rural communities of Lilongwe, Mangochi, Mulanje, Thyolo and Chikwawa districts are now aware of where to access sexual and reproductive health services. The program also conducts outreach services where the AGYW from hard to reach areas are reached with mobile sexual and reproductive health services.

Enelet is one of the girls from Malembe AGYW Club in Area 25 in Lilongwe that were trained to be peer educators under the AGYW Module. Apart from HIV information, they learnt about the importance and how they can access sexual and reproductive health services from their nearest health centres. As a peer educator, she replicates what she learnt by sharing the information with her peers.

According to Enelet, the coming in of the AGYW program has helped many girls to open up and gain the courage to access sexual and reproductive health services. “Most of us used to be shy to access things like condoms because we thought the doctors and those who might see us would be questioning our character. But now we know our rights and the benefit of accessing those services,” she said.

As a peer educator, Enelet said she ensures she has condoms in stalk all the time as she distributes to her peers. She collects the condoms from Area 25 health centre. She also escorts her peers that feel shy to meet the doctor on their own to access medical assistance on sexual or reproductive health services. “We were linked to our health centre and we know which room provides those services. So, it is easy for us now to access the SRH service we want than before,” she added.

A Mid Wife at Area 25 Health Centre, Evelyn Abaleka, who participates in the programme’s activities, said many girls within Area 25 are now accessing SRH services at the health centre because they know about the availability of the services besides being assured of their privacy. “The girls are being sensitized by Plan International to access SRH services when needed. With the help of their peer educators, the girls come to the health centre with a referral form specifying the services they want. But, before providing them with the service, we ensure that we counsel the girls so that they should make informed decision(s),” she said.

According to the ActionAid Malawi AGYW Manager, Francis Mbvundula, ensuring availability and easy access to sexual and reproductive health services among the AGYW is key in meeting the aim of the AGYW Module, which is reducing HIV incidences amongst AGYW aged 10-24.

“When girls have a chance to decide whether and when to marry and have children, when they are protected from HIV, remain safe from violence and are educated, then they can contribute positively to the economic growth of our country,” he said.

ActionAid Malawi is the Principal Recipient of the non-biomedical part of the Joint TB/HIV Global Fund Programme and is implementing the AGYW Module through five Sub Recipients (SRs). In Lilongwe, ActionAid is reaching out to 13,260 girls through Plan International as a SR, but also Chinansi Foundation and Family Planning Association of Malawi (FPAM) as Sub Sub-Recipients respectively.