Fistula, Child Marriages: The Stinky Affair In Malawi

By Arkangel Tembo, Panos

When she was forced to marry a 37-year-old man, whose name she did not know, but had met twice at their Fellowship church at night, Kate Kachokocho (15) from Chimteka Village, Traditional Authority Simphasi in Mchinji district cried bitterly.

On November 5, 2015, her two paternal aunts, she identified as Mai a Dando and Mai a Mosey accompanied her to her new husband’s home.

 My mother is the only one who refused but  my two unties could not listen  to her because they insisted it was time for me to get married  because they could no longer support my education as my mother banked on them. My mother had no say because she rely on my aunt for support,” Kate told The Malawi News Agency recently.

She said she wrote everything in a small book she put in a small plastic and stashed in their vegetable garden, a skill she learnt at school.

“When my aunts left, I cried and could not eat. At 16, I became pregnant. I was not ready to be a mom. I cried because my breasts had not fully developed and thought they could not lactate. I thought that my stomach would burst,” she said.

Because of their religious beliefs, she did not go to their local clinic for prenatal care. Elderly women from her church would assist her deliver her baby at home.

“I was in labour for three days. They told me my baby was lazy and would eventually come. They said I should be patient yet the pain was excruciating. They told me to push. I kept pushing but no baby came. I thought I would die, but I hung on because I wanted to tell my story one day,” she said.

After an intense labour, she gave birth to a baby girl.

Kate’s nightmare begun after a week.

“I could see urine and faeces dripping from my panties. I was not sure why this was happening and the elderly women who helped me deliver had not prepared me for this. I used a cloth to reduce leaks. I could smell the odour from my body. Everywhere I went, people moved away from me. I was worried and cried,” she said.

She kept her secret for two months. Her marriage also suffered.

“My husband wanted to become intimate and I could not because of my condition. He hit me and told me that he would make me eat my faeces if they continued to drip. My mother-in-law banned me from cooking. I would spend my days in a vegetable garden from where I received my meals. I eventually left the marriage,” she explained.

Back at her parent’s home, her mother told a neighbour who is also a community health worker to accompany her to the local clinic. Her mother did not want other church members to see her at the clinic.

“They told me it was fistula. It was my first time to hear such a word. I recited it as the nurse referred me to Tembwe health centre since I had developed an infection. I was told to go to Bwaila Hospital in Lilongwe where the infection was treated. I received corrective surgery last year and now happy,” she added.

UNFPA programme office responsible for Obstetric Fistula, Grace Hiwa mentioned that reconstruction surgery can usually repair fistula, yet those affected by this injury often do not know about treatment, cannot afford it and neither can they reach health facilities where treatment is available.

“We must address the underlying issues such as early, marriage and childbearing that put young girls at risk of suffering birth injuries such as fistula,” said Hiwa.

Spokesperson for Ministry of Health, Joshua Malango says the fight against fistula should be won and that government records show tremendous success.

He mentioned things like the new fistula unit at Bwaila District Hospital which was opened in 2012 and    has a new major theater and a 28 bed inpatient unit.

He said since  the fistula care center began work in 2010, 450 women have been screened for fistula and 265 surgeries have been performed

Malango also said the  Campaign to End Fistula came to Malawi in 2007 and that ever  since, UNFPA and its partners have been flying in foreign doctors to work with local clinical staff in conducting repair surgeries, increasing mass awareness and linking fistula clients with health facilities which offer treatment, care and support.

“Government wants to ensure everyone is aware that fistula is a treatable condition and that patients should not be discriminated against,” says Malango.

On current interventions, Malango says the Ministry of Health is working with development partners like UNFPA, Freedom from Fistula Foundation and other organizations to tackle the issue.

“The major intervention that we are doing now is sensitization campaigns on the dangers of early pregnancy which is also one causative of fistula,” he said.

 “We also have  people who recovered from fistula   that are going out in the rural areas trying to convince fellow  women who have the problem of fistula to be assisted medically,” Malango said.

The ministry is also working towards increasing the number of facilities where fistula patients can find help and access medical treatment.

Plan Malawi Project Manager in Mulanje, Jane Mweziwina notes that statistics indicate that the incidence of teenage pregnancies remains high in Malawi and as such there is need to direct interventions towards both child marriages and teenage pregnancies if the country wants to be successful in this fight. 

“Government took a very positive step to amend the constitution which among others set the minimum age of marriage at 18. However, there is need to popularize this law such that people in the community should understand it. There is also need for enforcement of this law,” she said.

However, she said Plan Malawi is using an integrated approach to address this issue.

Mweziwina said that in the first place they are looking at the drivers of child marriages in Malawi in general as well as in the specific areas that Plan is working.

For instance, she said Plan Malawi have done many interventions like girl empowerment and community engagement.

In girl empowerment, she said it involves building the agency for the girls to be able resist child marriage and focus on achieving their desired future.

“This is done through various training in life skills, interpersonal communication and relationships, advocacy and several others. Girls and boys aged between 10 and 14 are provided with spaces where they interact with mentors who share with them these knowledge and skills,” said Mwezina.

In community engagement, Mwezina said Social cultural norms and traditional practices are some of the key drivers of child marriage and that it is for this reason that Plan engages with various groups of people who have influence in the community to support these boys and girls to stay in school and complete their education and not get married.

“These include the chiefs, religious leaders, traditional initiators and of course the parents. Through this initiative we have seen some of chiefs implementing age specific initiation ceremonies. This involves setting a minimum age for one to go for initiation rites,” she said.

Public Health Programme Manager of Panos Institute Southern Africa Mamoletsane Khati urges all concerned stakeholders; parents community leadership, decision makers, to take proactive actions to end child Marriage.

“The parents who think marrying off a child will improve their economic status to lawmakers who needs to ensure that the laws are not contradictory and can guarantee protection of girl’s rights. The state should also ensure that the supportive legal framework is implemented. Girls should know the value in education in addressing poverty and should be in school to improve their future opportunities,” says Khati.

Ending child marriage and its dreadful consequences require a multifaceted approach focused on girls, their families, their communities, and, equally, their governments. Culturally sensitive programs providing families and communities with education and reproductive health services can help end child marriage, with its attendant early pregnancies, illness and death in young mothers and their children.

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