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Secret Women

In Chichewa, the widely-spoken language of southern Malawi, being pregnant or “kunkhala ndi pakati” translates to being in the middle of life and death.  For many pregnant Malawian women, however, death comes much sooner.

As the African country with the second highest maternal mortality ratio, Malawi is struggling to eradicate a crisis that in 2006 claimed the lives of would-be mothers at a rate of 807 deaths per 100,000 live births.  And while 2006 figures showed an improvement on those of 2004 – 984 deaths per 100,000 live births – the 2010 Malawi Millennium Development Goals Report has already projected that Malawi will not achieve the targets of the fifth MDG to improve maternal health by 2015.

Contributing factors identified in the 2005 Ministry of Health (MoH) “Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity in Malawi” include shortage of staff and weak human resource management, limited availability and utilisation of quality maternal health care services, and weak procurement and logistics systems for drugs, supplies and equipment.  Underlying such problems of infrastructure and resources, the report reads, are harmful social and cultural beliefs and practices.

Naswit Chitalo of Namila Village in Traditional Authority (T/A) Mlilima in Chikhwawa District is easily able to recall a time when “most pregnant women were dying from pregnancy complications” because of social and cultural beliefs, which include the belief that the firstborn child should be delivered by a traditional birth attendant (TBA) in the home as opposed to a health facility.

“I actually know of three women we lost in 2009 because they sought the services of elderly women from the village instead of rushing to the hospital,” said Chitalo, adding that TBAs would use herbs to make pregnant women “feel so confident about the outcome of their pregnancy” that professional maternal health care would be neglected altogether.

According to Malawi Health Equity Network (MHEN) Executive Director Martha Kwataine, these kinds of social and cultural beliefs surrounding TBAs have done more harm than good when it comes to maternal mortality in Malawi.

“There have been several researches whose results have shown that traditional birth attendants have made cases on maternal death high because they are not properly equipped,” said Kwataine.  “We tried to train them so that they should handle referral cases but they did not comply.”

President Joyce Banda has also added her voice to the case against TBAs; on June 18, after laying a foundation stone for a maternity holding shelter at Mulanje Hospital, the first of 130 holding shelters pledged as part of the Presidential Initiative on Safe Motherhood launched in April, Banda told TBAs to stop offering delivery services to expectant women.

“Traditional birth attendants must stop giving delivery services,” she said at the function, adding that “traditional birth attendants can have a good role to play… because they are experienced they can be referral point.”

News of the ban on TBAs has been met with both controversy and commendation throughout the country.  But to women like Chitalo, the rationale behind the ban is not news at all; as one of the T/As where the Centre for Alternatives for Victimised Women and Children (CAVWC) has been working to realize the MoH Road Map objective of improving obstetric care, a new, “good role” for TBAs is already one of Mlilima’s best kept secrets.

Former traditional birth attendant Dalia Issa stands with her husband outside of their Namila Village home. In 2010, with training from the Centre for Alternatives for Victimised Women and Children, Issa stopped offering village-based delivery services and took on a new role as a Secret Woman. Photo submitted.

In 2010, CAVWC identified two women in each village of T/A Mlilima and T/A Kasisi to be “Secret Women.”  The women, many of whom had been working as TBAs, attended three days of training on maternal health using a standardized MoH handbook.

According to CAVWC Project Officer Talimba Bandawe, women like Chitalo were trained to take on four main roles and responsibilities: referring pregnant women to antenatal facilities by carrying out door-to-door campaigns; educating women on family planning; collaborating with Village Health Committees to form Community Safe Motherhood Task Forces and conduct awareness-raising community meetings; and recording how many pregnant women deliver in the community or in a health facility.

“We depend on these Secret Women because they have been trained; they can convince a woman on the importance of delivery at a health facility with a skilled attendant, because in the rural areas they are used to having TBAs,” said Bandawe.  “We’re trying to change that mindset – that anything could happen with a TBA so it’s better to deliver at a health facility.”

Bandawe said the women are called “Secret Women” because of the social and cultural beliefs and practices surrounding pregnancy in Malawi.

“When you talk about traditions and beliefs, the pregnant woman is vulnerable,” she said, adding that traditional beliefs in witchcraft scare some women off of sharing how many months they are into their pregnancy.

“The concept of Secret Women is based on that whatever you talk about with a Secret Woman should be kept confidential,” she continued.  “Whatever issues that you discuss, the Secret Woman is not expected to go and disclose that anywhere because some of the things can be really private.”

According to Esnart Dzoma, who has been volunteering as a Secret Woman in Namila Village for two years, “the most important thing is confidentiality.”

“If I begin to shout that ‘so and so sought this help from me’ they will inform each other, and we will have the health problems that used to compound issues such as pregnancy again,” said Dzoma.  “I have an obligation to help these women with compassion, and without malice… the secret to being an effective Secret Woman is to be open-minded.”

Based on principles of compassion and confidentiality, Bandawe said the Secret Women project has helped to address some of the harmful social and cultural beliefs and practices, “especially through the door-to-door campaigns” as pregnant women have been comforted by and more likely to accept confidential counselling.

A bicycle ambulance donated by the Centre for Alternatives for Victimised Women and Children being used in Namila Village. Photo submitted.

“The Secret Women were really successful in that a number of women were referred to the hospital,” she said, adding that other Road Map interventions such as the provision of bicycle ambulances and village bylaws enforcing fines for births that take place outside of a health facility have also contributed to the success of the initiative.

The data collected by the Secret Women also speaks to their success; in 2009, when CAVWC was working to reach out to practicing TBAs and provide safe-birthing training and equipment, approximately 30 percent of pregnant women in the two T/As were reportedly giving birth at a health facility.  In 2012, the Secret Women are reporting that 54 percent of pregnant women are now giving birth at a health facility.

But despite their success, Bandawe said that the new role for TBAs has not been implemented without resistance.

“Some women still resist the counseling of the Secret Women, and sometimes even the husband can be a challenge,” she said.

“There are some materials that the hospital recommends that you should have when you go to the hospital – a plastic paper, a razor blade and a basin.  Some of the husbands don’t welcome this idea, so (the Secret Women) have a negative reception from some of the families.”

For their part, Bandawe said that CAVWC will “revive the Secret Women” by holding refresher training courses at the end of June.

“It is really important to have these sorts of people in the communities, mainly in the rural areas where literacy levels are low,” she said.

“Maybe after there has been a lot of sensitization, when everyone even in the rural communities is aware of the health benefits of delivering at the hospital and when we have managed to reduce the maternal mortality ratio, that’s when we can do without the Secret Women.  But right now, they still have a major role to play.”

***

With files from Richard Chirombo and Madalitso Musa

How Malawi will remember late president Bingu Wa Mutharika

Bingu Mutharika passed away after suffering cardiac arrest on April 05, 2012

Bingu Wa Mutharika, former president of Malawi, died after suffering cardiac arrest on April 5, 2012. Photo by Desiree Buitenbos

The flag flies at half mast outside Malawi’s parliament building where thousands of civilians have braved long line-ups in smoldering hot sunshine to view the body of late president, Bingu Wa Mutharika, who died after suffering cardiac arrest on April 5, 2012.

To an outsider, this seems like a country truly mourning the loss of their beloved leader. Radio stations and newspapers are bombarded with messages of condolence, while government offices have shut down for the next 30 days.

And though some might argue that the sheer turnout to see Mutharika’s body is evidence of his vast popularity, there are others who say that nothing could be farther from the truth.

Precious Gondwe, 34, has been waiting in a queue to enter parliament for nearly two hours, and her determination to view Mutharika’s embalmed body is fuelled by a desire for closure rather than respect.

“I came here to see with my own eyes that our president is no longer with us,” says Gondwe, “It’s funny that we are lining up to see him when he is the reason we line up for essentials like petrol and sugar.”

Gondwe’s views are not uncommon.

According to Chijere Chirwa, a politics professor at Malawi’s Chancellor College, the lack of mourning among some Malawians can be characterized as “strange” but not unexpected considering the recent failures of Mutharika’s regime to uphold democratic ideals and improve the living conditions for the 74 per cent of the population who survive on less than a $1.25 per day.

“A lot of the critical minds would regard the current economic, social and political situation as developments closely connected with the president,” says Chirwa.

For the past two years, Mutharika, once hailed by the World Bank for his successful fertilizer subsidy program, steered Malawi’s economy into steep decline by telling foreign donors who contribute 40 per cent of the annual budget to “go to hell”.

His dismissal of aid catapulted the government into the adoption of a zero deficit budget which subsequently affirmed that the small landlocked country couldn’t self-sustain with limited resources.

More than 80 per cent of Malawians rely on agriculture for their livelihoods, and tobacco is the country’s main crop, as well as its primary generator of foreign currency. But since 2011, sales of the golden leaf have plummeted by a dismal 57 per cent resulting in reduced finances to purchase fuel from suppliers like Saudi Arabia. This scarcity coupled with a fixed exchange rate has increased consumer inflation to a staggering 10.9 per cent.

According to Voice Mhone, chairperson for the Malawian Civil Society Organizations, the months leading up to Mutharika’s death were overshadowed by rampant dissatisfaction.

“I think the political landscape, as well as the economic situation in Malawi kept on deteriorating,” says Mhone.

“Staying in a queue for fuel is now part of our daily life, and if you look at the price of sugar and other essential commodities they have all skyrocketed.”

On July 20, 2011, the anger and frustration surrounding the country’s economic crisis culminated in mass demonstrations calling for the president’s resignation. These peaceful protests soon turned into bloody riots when police opened fire on innocent crowds leaving 19 people dead and scores of others injured.

But Mutharika didn’t accept blame for the deaths, nor did he take the public criticism to heart; instead he began a vigorous campaign to clampdown on critics, media and opposition leaders.

Reverend Macdonald Sembereka, a civil and human rights activist who played an instrumental role in organizing the protests, had his home petrol bombed by suspected government youth cadets last September. But he says that while the nation has gone through a turbulent time, he has no hard feelings towards Mutharika.

“He did contribute what he could contribute. If he failed that would be part of human nature,” says Sembereka. “I’ll remember him as a person who stuck to his guns. When he wanted to do something, he would stick to it, even though the whole world would stand on the opposite side.”

At Mutharika’s funeral in the southern region of Thyolo, recently inaugurated president, Joyce Banda summed up his life with the sentiment of the nation, saying, “He was not an angel, he made mistakes”.

For Banda, Malawi’s first female president, the road ahead is littered with the legacy of those mistakes, and the latter has prompted her government to resume donor talks with the International Monetary Fund, and the World Bank.

The Daily Times newsroom.

The future of press freedom in Malawi

Joyce Banda was sworn in as Malawi’s newest president on April 7 under the terms of the constitution, following two days of political uncertainty after the sudden death of the late Bingu wa Mutharika.

Having won national and international recognition for championing the education and rights of underprivileged girls, Banda’s ascension to the state house has raised hopes for a fresh start for the impoverished nation.

But in a place where a two-day national news blackout left Malawian media scrambling to ascertain the fate of the late head of state, what can be said for the future of press freedom under the new leader?

According to Daniel Nyirenda, deputy editor of The Daily Times and editor of The Business Times, it will take more than a transition of power to translate into improved media freedom.

“We are at a period now where there has been a suppression of media freedoms,” said Nyirenda, citing “bad laws” for press freedom that were enacted during Mutharika’s second term of office.

“We’ve also seen threats from the executive arm of government on the media and the banning of advertising to media that is unfriendly to government,” Nyirenda added.  “Reporters or even newspapers are afraid to publish certain stories for fear of getting a backlash from the executive arm of government.”

When asked if rights media might improve now that the executive arm of government is under Banda’s new leadership, Nyirenda said he is unsure.

“In my view, I think much won’t change because it’s the same people really, just wearing new clothes.  In Malawi, we have people who believe in controlling the media…so much won’t change.

“But, I’m hopeful that now that (Banda) has tasted life in the opposition she has learnt a lesson and she might be more flexible in the way she handles the media.”

Based on comments from The Daily Times’ current chief reporter, Charles Mpaka, Nyirenda’s hope may stand to come true.

While Mpaka said that colleagues working longer in the industry have testified that Banda was averse to criticism from the media and personally attacked journalists when serving as a minister, he added that after she was ousted from the Democratic Progressive Party (DPP) in December 2010 and started her opposition People’s Party, “she was reachable on her phones and willing to talk all the times that (he) phoned her.”

However, he added, the interviews were on issues serving her interests.

“From the experience that I have had with Malawian politicians, I would not rush to conclude that things will get easier for the media.  Politicians do change when they get the power and influence.”

When asked what needs to change to usher in a new “normal” for press freedom in Malawi, Nyirenda said that it’s not the people that need to change but the system.

“We still have a hangover of one-party dictatorship in our laws,” said Nyirenda.  “We also need to change MBC (Malawi Broadcasting Corporation) from a state-controlled institution to a public institution.

“We need to reviews these things – then there will be adequate press freedom in this country.”

This article was originally published on the Toronto Star website on May 4, 2012.

The story behind Malawi Vice President Joyce Banda’s dedication to women’s empowerment

Malawi Vice President Joyce Banda traces her lifetime commitment to the economic empowerment of women to a childhood spent in the village. Photo by Travis Lupick.

It’s often fascinating to hear from where an activist found their dedication to a cause.

I’ve interviewed a young victim of molestation who openly shared her story in the hopes of letting abused children know that they are not alone. There was a bereaved mother who founded an experimental drug rehabilitation centre after her son overdosed while backpacking in Thailand. And I’ve met plenty of convicted criminals who now work to prevent youth from making the same mistakes that they did.

More recently, in Malawi, several women carrying the HIV/AIDS virus bravely broke cultural taboos and let their names and stories be publicized in order to spread awareness of the disease.

Another favourite inspirational story I’ve enjoyed since arriving in southern Africa is that of Malawi’s vice president, Joyce Banda.

“I have worked in the area of economic empowerment and education all of my adult life,” she told me during a recent interview at her office in Blantyre. “For me, it is about poverty eradication.”

Growing up with a police officer for a father, Banda has spent most of her life in the city, she began her story. But for many years, her grandmother forced her to spend weekends in her family’s village, lest that be where Banda’s fate one-day take her.

“So I had a very good friend in my village whose name is Chrissie,” Banda said. “She taught me everything about village life and she was brighter than me in school.”

Both girls completed their primary studies, the vice president continued. “And she was elected to go to Saint Mary’s and I was elected to go to Providence. She went one term, but her parents couldn’t raise the six pounds that we needed for her to go the second term, so she dropped out and went back home.”

That was when the girls were 16 years old, Banda recalled.

“I went on, finished, and now I am vice president of this land,” Banda said, matter-of-factly. “She is locked up in the village, in poverty. And it makes me angry when I see her. I say, ‘Why am I here, and she is not?’ For that reason, I decided that I was going to spend my life working to economically empower women.”

Banda, the country’s first female to hold an office as high as vice president, has since gone on to help Chrissie start a bakery, she’s establish schools and orphanages that focus on educating girls, and Banda continues to financially support hundreds of young women’s educations.

“Chrissie is very bright,” Banda said. “But she lost out; I cannot support her education. But I can spend my life supporting people like her….So for me, again, it is the eradication of poverty, focused on education, health, and the economic empowerment of women.”

Follow Travis Lupick on Twitter: @tlupick.