Contraceptive Access in Malawi Allows Women to Have Choice Over Their Futures

Every three months, Bernadette Daluni had the same routine.

She laced up her shoes and began the 4 kilometer (about 2.5 mile) walk in the blistering heat to the nearest PIH-supported health center.

There, her skin was pierced with an injection of Depo-Provera, a contraceptive-and then she began the long journey home.

Daluni lives in Malawi's Neno District, a remote district in one of the poorest countries in the world. She and her roommate scrape together money each month so they can stay in a small home near Wongani Private Secondary School, where both young women are students.

Few people in Malawi, where Daluni lives, ever attend university.

Only 24% of male students and 22% of female students finish lower secondary school, according to the United Nations Educational, Scientific and Cultural Organization (UNESCO). Even fewer-approximately 14% of female students and 15% of male students-finish upper secondary school.

These percentages tend to be even lower for girls who live in rural areas, like Daluni.

Approximately 1% of college-aged students in Malawi attend university, making the country's tertiary education rate one of the lowest in the world.

Young women and girls frequently drop out of school after becoming pregnant-with a 29% teen pregnancy rate. Daluni has watched numerous classmates leave school for that very reason.

But she has different dreams.

Daluni wants to be one of the few people who not only go to university, but graduate from it. Her ultimate goal is to study nursing and return home to Ndelema Village, where she could serve her community through medicine.

And it's why-despite the grueling trek to the health center, the injections, and the side effects-that she continues to do what she must to protect her future dreams.

Working tirelessly for the future

Daluni learned about contraceptive access and options through the Teen Club, a group created by Abwenzi Pa Za Umoyo (APZU), as PIH is known in Malawi.

The Teen Club was created to connect adolescents living with HIV in Malawi to one another. It bolsters social connection, while also acting as a resource on HIV-treatment and safe-sex practices.

There, Daluni met Yvonne Mission, another young woman with big dreams. Mission joined the Teen Club in 2014, just two years after Daluni.

Yvonne Mission from Neno District returned to school with support from PIH Malawi. Mission, who is HIV positive, uses contraceptives and encourages other young people to make informed health choices. Joseph Mizere / PIH

Like Daluni, Mission tested positive for HIV at a young age. When Mission's father died, her mother, Flossy, was left to care for her two children by herself. Flossy had to make hard financial decisions for the family: she could either afford her children's schooling or their basic needs-including food and housing-but not both.

The choice was clear.

Mission dropped out of school, but found community and hope through the Teen Club. Eventually, APZU TB and HIV Officer Charles Phiri began talking to Mission more about school. He learned that, like Daluni, Mission had dreams of going to university and studying medicine.

Phiri helped enroll Mission in PIH's Program on Social and Economic Rights (POSER). POSER aims to address the social determinants of health and break the cycle of poverty. Part of this is helping people afford an education.

With support from PIH, Mission was able to enroll back into school.

However, as a young woman, Mission also began to need reproductive care. She, too, feared dropping out of school from an unplanned pregnancy. However, she was also afraid of going on contraceptives, especially because she worried it would prevent her from conceiving later in her life.

With education and support from members of PIH, Mission made the courageous decision to begin accessing contraceptives. After getting essential health care and school supplies paid for, she is now waiting for her Malawi Junior Certificate Examination results. Her score will allow her to progress to senior secondary school-Form 3 and Form 4-the last courses on her path to qualify for university education.

Daluni, meanwhile, is still in secondary school and preparing to eventually take the college entrance exams. After experiencing side effects from her injections, she was able to work with her health care provider to find a better contraceptive fit, allowing her relief from symptoms and more time to spend on her studies.

Her grandparents, 81-year-old Witika Chitsate and 76-year-old Kelita Joffat, do backbreaking work on a small farm to pay for Daluni's tuition.

Despite severe damage from Cyclone Freddy in early 2023, Chitsate and Joffat continue to grow maize, tomatoes, okra and eggplants to make sure their granddaughter can get an education.

Some terms, Daluni must wait to enroll in school until there are enough crops harvested and sold to afford the 50,000 MKD-or $28.85-per semester school fees.

Contraceptives are essential health care

Contraceptive access is essential to Mission, Daluni, and so many other young women and girls like them around the world.

Without access to free health care, Daluni and Mission would be put in an impossible position: spend their money on the daily needs that keep them alive, or forgo some of them to afford health care that protects their future.

Mission said cutting off access to contraceptives would endanger her future by removing her ability to plan her life. With continued support, PIH can keep helping women and girls in Malawi access essential health care, education, housing, and other basic needs.

This support is more important than ever, given the Trump administration's dismantling of foreign aid programs through the U.S. Agency for International Development (USAID).

United States taxpayer money was used to purchase $9.7 million worth of contraceptives-products that could be life-changing and cause positive social and economic ripples for years to come-but they now sit stagnant in a Belgian warehouse.

The U.S. aims to burn these essential medical supplies, despite multiple organizations offering to purchase and distribute the products themselves at no additional cost to the U.S.

Approximately 77% of the contraceptives are earmarked toward five countries in Africa, including three that border Malawi: the Democratic Republic of Congo, Kenya, Tanzania, Zambia and Mali.

While it is unlikely these contraceptives would have gone to the regions Daluni and Mission live, it is clear this decision could disrupt the futures of numerous people with similar lives and experiences: women and girls who are working tirelessly to break cycles of poverty.