03 April 2024 by Limpho Sello

 Est Read Time: 6 min(s) 8 sec(s)

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Molikaliko Health Centre’s Nurse in Charge, Mabokang Damane-Ntsie, discusses the center’s improved access to contraceptives, courtesy of donations from UNFPA, facilitating better Sexual and Reproductive Health services.

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32-year-old ‘Mamolemo Fako’s phone alarm rings, reminding her to take her daily oral contraceptive pills.

Fako and her husband, married for two years, have decided they are not prepared for children yet. To avoid unplanned pregnancies, she diligently sets a daily reminder on her phone.

“The main reason I opted for contraceptives is because I am not ready to become a parent at this point. Additionally, my husband does not like having children,” Fako shared with Uncensored News on March 19, 2024.

Speaking from Ntlholohetsane, Mokhotlong, she discussed her decision while at Mokhotlong Government Hospital, where she sought sexual and reproductive health services.

“I initially tried Depo-Provera but discontinued due to unbearable side effects like frequent headaches. Now, I rely on oral contraceptive pills,” Fako explained.

Several kilometers away from Mokhotlong Government Hospital lies Molikaliko Health Centre, situated in the hard-to-reach areas of Mokhotlong district. It was here that a 22-year-old man from Senqu brought his 15-year-old wife for a family planning appointment, where she received contraceptive implants to prevent early and unintended pregnancy.

On March 20, 2024, a group of health journalists from Maseru visited Molikaliko Health Centre under the auspices of the United Nations Population Fund (UNFPA) to evaluate the impact the commodities donated to the government of Lesotho through the support of China International Development Cooperation Agency in 2021.

Also read: https://www.uncensored.org.za/empowering-nurses-oxygen-concentrators-reshape-birth-deliveries-in-lesotho/

Nurse in Charge, Mabokang Damane-Ntsie, shared the story of *Lereko and his young wife with the journalists.

“He described how, after marrying his young bride, her parents urged them to postpone falling pregnant,” Ntsie relayed.

“He emphasised that risks associated with his wife becoming pregnant at the age of 15 were fully explained to him, prompting his decision to arrange for her to receive contraceptive implants.”

Ntsie clarified that Lereko informed them that they intend to have their first child when his wife reaches her 20s.

Ntsie recounted that the man expressed to Molikaliko Health Centre officials that he married a young girl out of concern that if other men were to marry her, he would lose her permanently.

Battling against the alarming rates of child marriages

In many areas of Mokhotlong, particularly in the catchment area of Molikaliko Health Centre, early and unintended pregnancies (EUPs) and child marriages are unfortunately normalised and perpetuated by some parents.

Ntsie emphasised that marriages involving individuals under 18-years-old are illegal in Lesotho and highlighted the health risks associated with early childbearing.

According to SolidarMed, teenage pregnancies pose significant health risks for girls aged 15 to 19 worldwide, including death due to birth complications, primarily stemming from a heightened risk of eclampsia and uterine infections compared to older women.

Additionally, the stigma and distress associated with becoming pregnant at a young age often lead to unsafe abortions. The organisation further highlights that in teenage pregnancies, babies are more prone to being born prematurely or with low birth weight.

The National Library of Medicine also suggests that there is a report indicating that 38 million adolescent girls require contraceptives to prevent unintended pregnancies, yet more than half of them are not utilising an effective method.

It notes that: “Meeting the unmet need for modern contraception of women aged 15–19 would reduce unintended pregnancies among this group by six million annually. That would mean averting 2.1 million unplanned births, 3.2 million abortions and 5600 maternal deaths.

“The dramatic reduction in unintended pregnancies would spare women and their families the adverse consequences of early child-bearing, reap savings in maternal and child health care, and boost women’s education and economic prospects.”

According to the United Nations Population Fund on Adolescent Pregnancy , girls aged 15-19 years face a significantly higher risk of maternal mortality during childbirth compared to women aged 20 years and above, with the risk being twice as high.

Additionally, unsafe abortion due to unwanted pregnancy is prevalent among adolescents, highlighting the unmet need for contraception among girls and women.

In sub-Saharan Africa, factors such as extreme poverty, UNFPA notes that limited access to reproductive health information and services, and restrictive abortion laws often lead women to seek clandestine abortion providers to avoid unintended pregnancies.

As a result, approximately 3 per cent of women in the region undergo unsafe abortions each year. Unsafe abortion is a major contributor to maternal deaths, with approximately 14 unsafe abortions performed for every 100 births in Africa.

Ntsie emphasised that they are tirelessly working to combat early and unintended pregnancies in the area, but they often face an uphill battle due to the prevalence of normalised child marriages.

Despite the challenges, Ntsie acknowledged that Mafulane and his young bride sought family planning services at Molikaliko Health Centre, where they received assistance to prevent early and unintended pregnancies.

“We consistently educate and counsel parents to encourage their children to participate in adolescent day sessions, where they can receive further education and information on preventing early and unintended pregnancies as well as infectious diseases,” Ntsie stated.

She revealed that between April 2022 and March 2024, they recorded 31 cases of early and unintended pregnancies (EUPs) involving girls aged 17 and younger. Among these cases, five girls were 16-years-olds, while one was just 15-years-old, indicating that the majority, 29 in total, were 17-years-olds.

She expressed concern that within their catchment area, which has a population of 9,800, it has become common for children to become parents.

“Young girls as young as 15 years old are giving birth, and unfortunately, parents often perceive this as normal,” Ntsie lamented.

Thank God for the in-laws.

In Ntlholohetsane, Mokhotlong district, ‘Mamolemo Fako shared how his mother-in-law has embraced the idea of not rushing to have children.

“What makes our decision easier to maintain is the absence of any familial pressure to start a family,” Fako explained, noting, “My mother-in-law fully respects her son’s stance on parenthood.”

She explained that her mother-in-law has not pressured either of them to have a baby, creating a supportive environment for them to plan their family according to their own preferences.

While Fako is fortunate to have a supportive husband and understanding mother-in-law, Ntsie noted that this level of support is not always the case for other couples or women seeking to prevent unwanted pregnancies.

“Some women face challenges in using IUC and implants due to disapproval from their partners,” she explained, highlighting that this occurs despite extensive education on the benefits of long-term contraceptives, which could reduce their need for monthly visits to seek family planning services.

Meanwhile, Ntsie highlighted that with the support of UNFPA, they consistently have an ample supply of contraceptives, making it easier to provide Sexual and Reproductive Health (SRH) services despite the challenging geographical location of Molikaliko.

To overcome the barrier of distance for villages far from the health facility, Ntsie mentioned they conduct outreach programs with the assistance of other partners who provide transportation support.

“We also have a health post in Maloraneng where, with their assistance, we can send two of our nurses to deliver medication to sick patients and offer SRH services,” Ntsie added.

She further elaborated that, with the assistance of village health workers who have received intensive training, they are able to provide self-injection Depo (Sayana Press) contraceptives.

Village Health Worker, Mautloang Mokone from Ha-Moeketsane, Mokhotlong, demonstrates the administration of Sayana Press.

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“These village health workers administer the contraceptives to clients at their homes for self-injection. They then report back to us monthly on the number of doses administered so that we can request additional supplies,” she explained.

She revealed that clients have shown a strong preference for this method as well as for the Noristerat injection and oral pills.

Ntsie also noted that the community they serve understands the importance of contraceptives and family planning, but they generally prefer short-term methods over long-term commodities. “We respect their preferences as they have the right to choose what suits them best.”

Discussing the uptake of family planning services for the first quarter of 2024, Ntsie reported that in January, they had 45 revisits and one new visit, while February saw 99 revisits and one new visit.

“In total, we served 146 clients with family planning services during these two months, with injectables being the most popular method,” she stated.

Ntsie expressed optimism about these numbers, particularly as many clients were reached during outreach programs. She emphasised the potential impact of expanding their reach to areas like Ha-Rammeleke, which has a high population.

Additionally, Ntsie mentioned their health education program for young people, facilitated through what they call “adolescent days.”

“Since we lack a dedicated building for an adolescent corner, we have adapted by hosting an adolescent day every Friday. This day is dedicated to adolescents and herd boys, as herd boys are often involved in sexual relationships with young girls, leading to unintended pregnancies,” she explained.