Malawi: Engaging Local Leaders to Save the Lives of Mothers

Joyce Banda, vice president of Malawi
30 September 2011

Joyce Banda is Malawi's first female vice president. Before taking office in 2009, Banda served as a member of parliament, minister of Gender, Child Welfare and Community Services, and minister of Foreign Affairs under President Binguwa Mutharika.

At the age of 25, Banda and her three children were living with her abusive husband in Nairobi, Kenya. A growing women's movement sparked Banda's rebellious spirit in 1975. She walked out with her children and started garment-manufacturing business. Her success and a supportive partnership with her current husband moved her to help other women achieve financial independence and break the cycles of abuse and poverty.

Banda is a member of the Global Leaders Council for Reproductive Health, a group of 16 sitting and former heads of state, high-level policymakers, and other leaders committed to advancing reproductive health initiatives for sustained development and prosperity. Vice President Banda recently spoke to AllAfrica about her work in advancing reproductive health in Malawi.

You started out in civil society 25 years ago. Tell us more about yourself and how you became involved in maternal and reproductive health.

I have been through an abusive marriage and I am a victim myself of childbirth complications. In 1984, after having my fourth child, I suffered from post-partum hemorrhage. It occurred to me that the only reason I am alive is because of the status that I had, because my husband was a high court judge. He had a friend who knew a gynecologist who rushed and saved my life.

The questions that I asked myself after walking out of the abusive marriage was, 'What does it mean to those women that are locked in abusive marriages?' And, in 1984, after I went through those childbirth complications, I asked, 'What is happening to poor women? How many are dying while giving birth?' And I said to myself, 'I should never allow myself, as long as I live, to sit back when women are dying, while giving birth, giving life.'

So I started out by forming organizations - the first was in 1989. I felt that the economic involvement of women in Africa is the key to social and political empowerment so I established what is called the National Association of Business Women (NABW). That brought together 20,000 women, then 50,000 women. I looked at that mass and said, 'This is a great opportunity for me now to go into family planning and reproductive rights as well as maternal health.' And it coincided with the 1984 International Conference on Population and Development in Cairo. And so I became acquainted with the United Nations Population Fund (UNFPA) in Malawi, and from that time onwards I worked very closely with the UNFPA.

In fact, when the last [George] Bush administration cut out funding to UNFPA, Americans organized themselves to support UNFPA and they gave me an award in 2006 for the leadership that I have demonstrated in fighting death through childbirth. So that is what I have done in Malawi. Right now under the Joyce Banda Foundation we have 70,000 women. And in the NABW and the Joyce Banda Foundation we started providing information and family planning devices because I did research and found most women die in hospitals between the ages of 17-19.

How did you develop family planning initiatives in Malawi?

It occurred to me there is a stubborn link between education and maternal health in my country. So a poor girl grows up in the village and at age 13 finishes primary school, and because she can't go into secondary school (because of cost), she is forced into marriage. The community will encourage her to get married and you find that because their bodies have not matured, most complications occur in giving birth.

So I felt that apart from providing family planning, devices, pills and information there is also a great need to mobilize a rural leadership. Where I come from, where 85 percent of people are rural based, the traditional culture plays a role, and the chiefs have a very important role to play in fighting maternal death and encouraging people to use family planning concepts. So I found a network of chiefs and we found that where the chiefs took charge of their villages, accepted and internalized what was said, that it is them that can fight maternal death and that can help women live a better life. We find that a chief can say if any woman delivers in this village or if any birth attendant delivers a baby in this village there will be a fine. Women end up at clinics and then you will find in villages where this is practiced no women have died in the past three years.

And so because of the work I have done the African Union appointed me the Goodwill Ambassador for Safe Motherhood from 2009 to 2010 and that is when I worked again very closely with UNFPA to mobilize chiefs, grow networks and encourage chiefs, train chiefs in order to ensure that their villages are safe.

And what results have you seen in Malawi?

What we have seen is an improvement. Malawi was one of the two worst countries as far as maternal mortality was concerned. We were at 807 women dying per 100,000 births - the highest being Sierra Leone, which had been at war. What I have seen in Malawi is because of the initiatives and support USAID and others have given to the government of Malawi to make family planning accessible to rural people and accessible to the most vulnerable and the poor. Because of this, we have gone from 807 to 697 deaths per 100,000 births. Not that it is anything to be proud about but I think we must take pride in the fact that we have registered such reduction in death and we intend to continue.

During the Bush administration that is when the support for UNFPA was cut off completely. It was UNFPA and USAID that assisted Malawi with reproductive rights and maternal health and that is the time Americans formed the network to assist UNFPA to continue to deliver support to poor countries. When the [Barack] Obama administration came to power, we breathed a sigh of relief because we hoped we would get what we had lost during the Bush administration. We are threatened now because we are told that there are going to be budget cuts. As a member of the Global Leaders Council for Reproductive Health, we are at the time where we cannot loose that support - across Africa. And so we thought there would be an improvement with the Obama administration but it looks like we are going back to where we were six, seven or eight years ago.

What would you say to foreign donors that are contemplating sizing down their investments and aid packages in light of the global recession?

My request would be to look at reproductive rights and maternal health as a good investment because investing in the health of women has a multiplier effect in Africa. There is a link between maternal/reproductive health and poverty, and I believe there is a stubborn link between family planning and poverty. When we go out in the rural areas to speak to women and ask, 'Don't you think eight children are enough?' They tell you, 'You have money, I have children - that is all I have.'

And so for us there is no way the American government can cut its support for reproductive and maternal health initiatives or it will be a vicious cycle that will never stop. In order to assist Africa and fight poverty donors need to help Africa invest in women's health. It is the best investment they can make.

To what extent do you see a connection between security, poverty and women's issues?

The reason why I said investment in women's' health is the best investment they can make is because it is connected to poverty. It is the women that keep the African home; it is the women that grow the food; it is women that process the food; it is the women that stock the food. If the women are not happy, if the women are dying, then that can't happen.

Now in Africa, a continent where poverty levels are high, a country that can't feed itself risks strife. All these wars, all these fights, all these squabbles we see in Africa are all connected to poverty. Especially with youth that are discontented, that are frustrated and have no jobs, that have no food, that are fighting to survive. And you find that most of them are women as well. So for me investing in women is the best investment the United States government can make.

How might family planning connect to climate change and environmental degradation?

It is part of what they are calling the 'youth barge'. In three-quarters of the countries in Africa the majority are the youth and you find that they are getting married and having children. For me the way to answer that question is to say that the environmental degradation that we see in Africa is partly a result of that 'barge' - overpopulation of our countries. For example, in Malawi we don't have opportunities for the youth, so they are going about deforestation, cutting down trees, burning charcoal, and then the environment is degraded. So the only response I can have is to say that overpopulation ends up affecting our environment because cutting down trees is connected to poverty and a lack of opportunities.

How does Malawi stand in its pursuit of the relevant Millennium Development Goals (MDGs)?

The picture now is that by 2015 we might just make the child mortality expected levels of the Millennium Development Goals. But as far as maternal mortality there is no way we can do it. There is no way we can reach the expected levels; there is no way we can reach them in three and a half years. I believe our struggle against child mortality started out 30 years ago when family planning was being introduced in Malawi. There was so much resistance due to our traditional culture. They had to call it 'child spacing' in order to even influence the most affluent people to use it.

At the moment 85 percent of Malawians are rural based, and 64 percent of the people have been living below the poverty line for the longest time. I am told we have improved now to 45 percent. Malawians that are rural based are also the ones that are locked up in cultural tradition and to have that mind shift, to say that it is economical and it is more sensible for you to have fewer children, that has been the greatest challenge for Malawi. We have made strides now. There are so many opportunities for people but we need to continue to receive support in order to continue the fight, to make sure that communities put these plans into place. But I have seen that in those areas where we have engaged local leadership, we have been able to engage the most important people in the struggle for family planning.

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