How Trump Administration Policies Are Impacting SRHR in Malawi

18% of maternal deaths in Malawi are due to complications from unsafe abortion. Malawi also consistently fights against child marriage, gender-based violence, and maternal mortality. Emma Kaliya, director of the Malawi Human Rights Resource Center and Chair of the Coalition for Prevention of Unsafe Abortion in Malawi and Brian Ligomeka, head of Center for Solutions Journalism, talk to us about the sexual and reproductive health and rights landscape in Malawi.

Malawi faces a maternal mortality crisis due to lack of access to emergency maternal and neonatal care, has seen its fair share of gender-based violence (including intimate-partner violence and sexual violence), battles high rates of HIV/AIDS and cervical cancer, child marriage, and unsafe abortion, and seeks to improve maternal health outcomes by highlighting the safety of delivering in hospitals.

U.S. global health assistance has been utilized by Malawi in a way that has allowed them to make achievements and strides in sexual and reproductive health. But, because of the expanded Trump global gag rule (and the fact that clinics are having to scale back their operations or close down completely), unsafe abortions are on the rise in Malawi. This disproportionately impacts women and girls in Malawi that are most marginalized; those that live in rural areas, who lack education, and who are poor. 

It is far past time that the U.S. reevaluates the harmful, dangerous, and unnecessary global gag rule and support the independence, health, and prosperity of women and girls in Malawi and around the world.

Links from this episode

Malawi Human Rights Resource Center
Center for Solutions Journalism
UNFPA Malawi
CHANGE report – A Powerful Force: U.S. Global Health Assistance and Sexual and Reproductive Health and Rights in Malawi

Transcript

Jennie Wetter: Welcome to RePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Hi everyone. I am excited for today's episode. We are going to talk about sexual and reproductive health and rights in Malawi, and joining me today, I am really excited to have two amazing experts from Malawi and I'm going to let them introduce themselves so that you can learn more about them, but you can also know who's talking when. So who wants to go first? Emma, or Brian? Let’s do Emma, she's closest to me.

Emma: Thank you. My name is Emma Kaliya. I am the director of the Malawi Human Rights Resource Center and I also chair the Coalition for Prevention of Unsafe Abortion in Malawi which is a civil society organization but also is for individuals who have a passion for making sure that we do not have safe, unsafe abortions.

Jennie: Wonderful. Brian?

Brian:…and my name is Brian Ligomeka. I lead an organization in Malawi called Center for Solutions Journalism, an organization which specializes in promoting sexual and reproductive health and rights. But we do so mostly using the media, hence the name Center for Solutions Journalism.

Jennie: Wonderful. So I think before we get started, maybe we should do a little scene setting so people know-- they might not know a lot about Malawi and what the SRHR landscape is. So why don't you tell us a little bit about what are the prevailing issues in Malawi right now?

Brian: Well, Malawi is a nation in Southern Africa. We are about 20 million people. Yeah, there are a number of issues that are being discussed in Malawi. One of the problems, the obvious one is HIV and AIDS.... We are also fighting cervical cancer. We are fighting child marriages. And we are even promoting that women should deliver in hospitals instead of going to traditional attendance, lately…So I think those are some of the things, and I think my colleague can add the things that I've skipped.

Emma: Yeah, yeah, yeah…Of course we've improved from where we were in the old days. We would be talking over 1,120 are women dying when there are one hundred thousand live births. It has of course reduced now to about 400 women dying. And that is a huge problem. But because also, uh, it is the whole issue of the systems. We have systems that are overstretched and sit in issues that are preventable…

Jennie: Yeah. And I think also I had, I heard you talk about before gender based violence also being a large issue in Malawi.

Emma: Yes. It still remains a big issue like it is in many countries. Malawi did enact a rule on prevention of domestic violence in 2006 after realizing the magnitude of the problem at that particular time we thought maybe when we have it all things will improve. There has been of course a lot of progress in terms of awareness, but we're still seeing gender based violence, uh, which would include intimate partner and sexual violence and the main other things that at this time you tend to look back and say, uh, we going in a way where this problem has come to stay. So yes, it is and still remains one of our big problems in Malawi.

Jennie: And you're right, that's one of those kinds of universal everywhere problems.

Emma: Yeah. Yes.

Jennie: So one of the things we've talked about on this podcast before is the role of U.S. global health assistance. So global health assistance in Malawi, is it helpful? Is it hurting? Is it a mixture of both? Because of U.S. policy?

Brian: Well, I would say that for most of the allowance, including myself, we appreciate the assistance that the the U.S. government is giving to Malawi. We have been utilizing that assistance and it does help in Malawi-- make some achievements, but some of the new policies that have come into place is affecting the deliverables…one of these policies being the Mexico City Policy or the global gag rule. Some of us when we analyze it, it's not giving what is intended. At the moment because of that global gag rule, unsafe abortions in some parts of Malawi are on the increase because some of the service providers, which by the way I'm advocating for them, who are [engaging in] the prevention of unsafe abortion, are closing shop or scaling down their operations because funding has been withdrawn from them. The reason being that they are seen as if they are promoting abortion as a method of family planning, but the truth is that is not the case in Malawi. Abortion in Malawi is used to save the life of women or girls who are in danger. So what is happening is that the implementation of the global gag rule has consequences like the increase of unsafe abortions, which are resulting in many complications and in some cases they result in deaths of girls and the women. The same global gag rule is also impacting on the policies and laws that the Malawi government is the reviewing. And the next meeting, it's shining example is the, what we call termination of pregnancy bill. The Malawi government studied enacting that bill, but when the current president of our U.S., uh, the United States came into power and introduced the global gag rule, progress in the next mentor for the termination of pregnancy bill in Malawi. Nobody wants to point fingers at the U.S. government body.

Emma: You can read the big signs that it has that as well. Well, it's the, the whole issue of the U.S. government may be other governments saying, especially the U.S. government with the GGR, “we have not reduced funding. Maybe it remains the same.” Unlike my colleague is saying if the funding is the same, where does that money go? Does it need to address some of the issues, especially around the global health. Does that money address the issues of global health or in Malawi or it is diverted to other things and because those that were supposed to be receiving that money cannot receive anymore. There is an example in Malawi where an organization was implementing some services or was providing health care in certain areas, rural areas. But when this GGR came, it was a choice between you continue with this work or you dropped the other funding that you have that is towards issues of abortion and therefore this organization chose to continue with the other things was maybe for them it was about the values that they were standing for. That means taking away those resources, and that is very clear on that those resources and putting them in an organization that had no idea of service provision. Therefore those communities that were benefiting from any kind of, you know, general health services were affected. So the transferring of money away from this organization did not in the end save the same people…It may entail that we are creating a gap and that that money may in the end not produce any particular result. And hence we feel that we are grateful to receive this money at any level, but does it, do they reach out to the intended people, especially because of this. So maybe before it was okay and with the coming in of GGR, well the justification remains, we bring a morale but it's the way that it is being used.

Jennie: Yeah, it's really hard when you have providers that the community trusts that they have been going to that are no longer able to provide the services. There might not be someone who is easily taking over the services and definitely maybe not someone that the community already trusts to go to, to access, you know the allowed services.

Emma: Hmm. Yes. Yes. It's obvious they are, they are two things. Just the trust that you are talking about. These people do not even notice. These kinds of people that have come, they are not sure what they have come to do... Uh, at the same time we are even seeing communities questioning, “Oh are these people really serving our needs? Oh, are they saving us?” Of course we do not understand those people in the communities may not understand the GGR. They only know that they need to receive a service. So when these withdraws…our institutions that have been doing good work-- at the end of the day it is all for them-- they don’t even know that there is America behind all that. What they only know is that our government should have been providing that. But then the government is mum, you cannot say anything to please people because they know that may be a big brother somewhere is controlling using the remote control. So complexity and trust is toast. Next time you see another institution coming, people are not sure. They simply say no, we do not know these people…and people just end up dying in the villages.

Brian: Well yeah, as a matter of fact, there are even some cases where you had a clinical service provider who was providing services to the community and because you have discontinued funding to that service provider, that provider has closed the clinic and you take the money that was being given to this service provider. So there, there is the community that is suffering because the, you have given the money to an advocacy group, but that group did not provide productive. They say which people in that community were enjoying when they save is right now was in the operation. So there are these waste cases where you had the clinic and the clinic has now been closed because of lack of support which previously was being provided by the U S government.

Jennie: Yeah, and I think, you know, we talked to touched on it a little bit like this isn't just, people aren't able to get, you know, just basic services. These are people's lives and peoples are getting unsafe abortions. They may not be able to access a full range of care, other care and that you're seeing women dying.

Emma: Yes. I've said it time and again, “hey until that’s my own child, my own sister, my own cousin who is a woman dies., then I can start understanding.” People do not understand the impact of such things…And therefore, uh, when we were speaking we were speaking on things that we see in our communities that, they won't need to save this money so that you, when you serve it, you cannot attend. Which is not also usually available like you've seen in rural areas of Malawi, people have to travel all distance at times accessibility [inaudible] is not there. Maybe the actual ambulance is not even there to go and pick this person up. So they die in the villages. No, no, no. They will not even be statistics. Be sure that in that village today someone has died of this and therefore it just goes under reported. And for countries like the U.S. people are so far from us at times they do not understand the impact of some of these things that happen far away from us. But in the villages, as we stay there, we know how dire the situation is in our communities. So it is true and that we, we took policies to be more important than the lives people. And it does matter because it is not happening in my home. It is not happening in my country. At the same time, there is money that goes there, tax payer money that you'd have given. If it goes there, it has to do proper papers. It has to be useful. People say that would save lives of people. If we're talking about global health.

Jennie: So I was lucky enough to hear you to speak at an event yesterday and you were able to tell some stories from people that have been affected by the policies. Do you want to, I think one way to get people to really understand what is happening is to tell stories. Do you have something you would like to share?

Emma: Yeah. This is something that happened... There was a girl who was raped. She was 16 and she became pregnant and after becoming pregnant she wanted to access the service. Unfortunately, the facilitator that was offering the service in the area was closed due to global gag rule and this desperate girl had no alternative but to go to with traditional [unsafe abortion] and was administered cocoa this gal. Unfortunately, the girl started bleeding, then she died.

Brian: This is why to some of us, yeah, in the U.S. you can’t [see the impact] of the global gag. You can see global gag rule or Mexico City Policy, but in the rural areas in Malawi, the global gag grow is actually a death sentence. Poor iterate. Women who cannot access… it's serious because the clinic that was operating in their area has been closed. The problem is with the conditional set by the U.S. government. Even if that poor girl who was raped, had gone into a government hospital, should have been tended to, should have been told that she would not terminate her pregnancy because in Malawi, abortion is only restricted to save the life a woman who is in danger. We wanted it to address that, that even when girls and women are raped, they should be able to access the service, but the, the global gag rule has even affected the abortion law reform in Malawi. So yeah, in simpler terms, let's talk about the global gag rule in the boardrooms, but when we go to the villages, we are talking about the deaths that are emanating from unsafe abortions because women and girls were pregnant as a result of sexual assaults and cannot even access a service in the government because either the service provider is not there, or, when they say public service providers are there, they’re not providing this service or abortion is illegal in Malawi when we need to to make it legal for these women and girls who have been raped. You find that the policy in Washington D.C... [there needs to be] a reform process.

Emma: Yeah. I want to make an addition. We always say that minors are those that are below the age, but we wonder how you cannot allow your minor to have a [voice]. Yes because she's, she has been raped or she she's been defiled but [her age] goes to over 18 so then you say, because in Malawi we cannot provide this. Say you didn't have children, which is very sad…How can a minor reach out and, and keep that shout all the time. That life is ruined and that's where you know, we are speaking so much to say we should not allow this because it's breeding a society in which we say, “Hey that at the end of it all we can not even be able to support it.” Secondly, the governments like the government of America, the state government wouldn't be saying, and many people say that even after all people are lying, that the abortion contributes to Malawi’s maternal deaths. But it isn’t that 18% of maternal deaths in Malawi, it is because of unsafe abortion, complications of unsafe abortion … which should have been prevented and then we're saying it is okay because they are dying in the name of motherhood or death, the reason why they had died because if they would have been in go, there was no, it wasn't the issue of an abortion. Maybe it was complete…delivery so there was no ambulance to take them. You could just try those things. Maybe they would be understood, but things that are preventable and then we allow them to happen and then we just try them in the name of maternal death even for children and for adults, putting them together and saying women die when we didn't know why they are dying. That's where it becomes quite unfortunate.

Jennie: Yeah, I think it's so important because so often we just talk about the policy as a thing just like separate from the reality of the lived experience on the ground. And it's so important to hear from people in country who are experiencing the effects of it and to hear how it is impacting people's daily lives and that people are dying. And I think that gets lost so often when we talk about it being a bad policy, is not focusing on the people. Okay. So we always like to end with like an ask, but I think today it would be really good to talk about what would you like to say to the U.S. government on behalf of SRHR advocates in Malawi?

Brian: The message is straight forward, the global gag rule should be reviewed and at the best, repealed. You cannot celebrate that you have a policy which is sending women to their early graves. You cannot, you might not see it because you are a distance, but the, we as the citizens have been living in a country which has been benefiting from global health assistance, we are seeing that a policy has been met, we just turned the same assistance into a weapon of destruction. Appeal to the government in the United States to the administrators, even to the president and his entire team of the cabinet to review the policy. These policies look to achieving its objectives. When the American government is giving assistance to countries, the aim is to ensure that those countries are improving in number of their indicators in the economy, in the health sector… But when you are pumping aid to a nation and that aide, it's not achieving its intended objectives, then you need it to, to review some of the challenges that actually is making that aid ineffective. And in this, in the healthcare sector, one of the challenges is that the global gag rule has that negative impact. It is increasing unsafe abortions in Africa instead of reducing them, it is responsible for the death of women and girls instead of improving the health and livelihood of girls and women.

Emma: Yeah. Um, I have always wondered myself. We tend to compare at home to say when they introduced to the male to the conversation, the conversation was unjust and very short. Everyone was running everywhere. Anything to do with benefits of a male, is not an issue. Anything to do with women, it takes so much time for many people, including policy makers who have daughters, who have wives, who have mothers who brought them into this world, to understand that it is a violation of rights. Many times women's rights are taken like charity… they are not taken as substantive rights like say, the right to vote. You put on a scale, the right to vote becomes even heavier and then a right to a woman. So if in, if a woman dies, it doesn't matter. Provided we are voting. When we talk about issues of economy, if it is a bill have to do with money and economy, it will be passed within the shortest period of time. We've seen this at war. Where are bills that you work towards for the improvement of lives of women? It takes 10 years before they can even go see the them. But when it is something to do with money to be the following day, it will be in the parliament, they will discuss it quickly, and it will pass. And then you wonder, are women human beings, are are they are not human beings? Are they are second class citizens? And that is the question that keeps coming back to me to say why are we treated like second class citizens. Those thatwere in the villages. People think they don't contribute anything to development. If we did not have people in the rural areas, development of our countries should have gone down. If we did not have women contributing in whatever way they and in other sector our countries would never have developed. It is the same women that toil day in day out and really, why you do not just want to accept that women need to have to enjoy, their rights in full instead of restricting their rights. And this is the question for bigger members like the U.S. that is putting in so much resources in the name of, like my colleague has said helping poor countries, Malawi is one of the poorest countries and when our government is sitting back fairing to speak remaining mum, we are not surprised because they know if they touch this big brother, they just tried to provoke the big brother at times it can have you know, adverse effects in terms of our developmental agenda. Many things will stop because there's money that goes into Malawi as aid andmoney comes from other countries contributing to our budget and then therefore they would rather just keep quiet and look and see they have people dying. So really it is a big concern. The straight message, is that my colleague has said, timely recall seeing that this position, the people over America I, while yes we talk of the president by the people of America should start understanding… they are very far from us. There are certain things they may not know. Start understanding that you need also in own way convince the government in America that they got not continue this on this path. The is not right. They need to take a position which would be meaningful to those that are out there because we could see that this is taxpayer's money and morale in here that you did it to help people out there in a meaningful way.

Jennie: Emma, that amazing answer and reminded me of one more thing I wanted to ask you about and that is lately in the U.S. the administration has really been pushing programs around women's economic empowerment. I feel like maybe we should have a little conversation about women's economic empowerment without reproductive rights.

Emma: Yes, there are two issues. I think it is easy to talk about economic empowerment. So many programs that are introduced at times, I ask myself, they go micro. They at times are not even macro and economic empowerment in our countries which goes too micro. We'll just be saving the papers of a day to day survival and it does not change in economy the economy status of women. We are saying they need to introduce programs that would really change the status of women, connected to SRHR. If we believe that economic empowerment changes the way issues of GBV are viewed, then I think we seem to be missing the point because as I'm sitting here, a woman in America, in an office, I have a big cae I am driving, but go closer and there you discover this is so much independent but there is violence, even in the offices you are facing workplace violence, gender based violence and you are wondering this woman is economically empowered? Why is it that she's also facing the same violence that is, hidden but she is also get ashamed to speak about it because they know that out there people think that they are economically empowered. Some of the issues of race in SRHR that come out. Like one of the issues that my quality expansion, even issues of unsafe abortion, are happening within the context or economic empowerment that we are talking about and then out there you seem to be a woman with standards but inside there are certain things that are forced on you that you not even avoid but you are economically empowered in terms of money. But in the mind it is different. So issues are connected to SRHR, and some of us are saying one, we need to find better programs to educate people. Even those that are in, in good jobs, even those that are earning more so that they're able also to view issues of SRHR in a very understandable way. So they understand they connect things properly. They also interpret the implications of so many issues in their own right. Otherwise, the issue of record making going remains empathy. If there is no proper education. Of course many people can be, can go to school, but they do not understand these other things that can affect them in their lives. So yes, but American government is introducing so many programs. I know in Malawi, so many programs are about economic empowerment as I'm talking now, is it not the government of America that has given so much [inaudible] wanting to do small, small things for women. But the small things for me, not to me personally, I find them not meaningful. I have to end with this example. A woman in the house is given a business of chickens, so she's rearing chickens and then tomorrow morning the husband says, there is no food here. What will she do? You take the same chickens and use them for food. The business is there. They should make sure we are investing in bigger things that would be aimed at changing this, not recycling the same things and in people remain in the vicious cycle of poverty. So that we are still justifying aid in the name of people who are poor when we did not manage the other aid properly. So I think that's the way I see things myself.

Brian: But it is also important. Sometimes it's good to deal with it--the basics and the, the basics include food availability, shelter, and good health. This is three basics that should be dealt with. You cannot jump to economic empowerment before you deal with issues of health, food and shelter. Then you are missing the point because you can not empower a woman or a girl who has died from unsafe abortion. So issues of health, they should be addressed as a basic need, food addressed as a basic need. Once these basics have been addressed then we can graduate to the next level. Why should you jump into the last tier when things in the first tier are a mess. So you cannot achieve economic empowerment if you do not address the basics, the basic things that people need, issues of homelessness, should be addressed issues of food availability should be addressed. Issues of access to healthcare services should it be addressed. But the moment that you say, we skip the food, we skip the shorter, we skip access to good services and we will go to the higher level needs like economic empowerment, then you're not doing things in logical order and you're not even achieving the economic empowerment that you, you dream about. It's the wrong way to do things. It's the wrong way to do things. So why should government, they choose the wrong way to do things when there's a logical way to do things that can make people progress from poverty to economic empowerment that is there. So I think that's my contribution. If you don't address the basics, women will be dying, girls will be dying, people will be dying. So who will you empower? You empower people who are in the grief. That's my contribution that choose one of the basic needs that ought to be addressed… when the basics have been addressed. Then, you can go to look at things that are on the next level.

Emma: There's an addition to that. Maybe I may have missed it. Yeah. There is suffering from issues of malaria. Many people are dying because of malaria. In some countries they haven't dealt with it once. And for it we receive a lot of money around issues of what, addressing issues of malaria. I get a bit upset myself because I feel like, what is it that other countries have done to deak with issues of malari, but we're still being made to receive eh, mosquito nets in the villages where they don't even have a bed. So they put it on the mat and it gets damaged the same day you receive it. Whereas to me to receive drugs that are not good at all, they make you even more sick. So for poor people who have no food, like my colleague is saying, these things are taken like, you know, like you said, basic. So until those that support us understand that all these things that we're talking about, uh, issues of rights, they are not issues of saying, “okay, it is okay, maybe tomorrow.” They're not issues of charity, and that our governments have an obligation. The development of aid that comes or those that are giving aid should have I responsibility as well, to making sure that we are moving steps we are not going back and forth, moving to one step forward and two steps behind addressing the same issue that we're addressing 10 years ago. I think like he said, we need to reflect and say how best can we address? Malawi is a poor country. We have so many other things that have to happen. We can invest in issues of education who then invest in issues of health. We should not be addressing the same issues have been addressing above for the past 10 years. This should be completely avoided because it's like again, we're moving on a roundabout we are not going anywhere but round and round and we don't seem to know which direction we are taking so that I think that is my contribution as well. Just to add on what he has said that I think we'll have more to do than what we see.

Emma, Brian, thank you so much for doing this. It has been a pleasure to talk to you. Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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