A supply gap in contraceptives to village health workers (VHWs) in Mokhotlong district is threatening to undo other efforts meant to combat early and unintended pregnancy in the community.
The presence of a large construction project, the Polihali dam, which has employed hundreds of male workers, has increased the need for contraceptive supply in the district.
Mokhotlong already has the highest unmet family planning rate of 25 percent against the national rate of 18 percent, according to the 2014 Lesotho Demographic Health Survey (LDHS).
Village health workers (VHWs) in the district recently expressed their frustrations of having undergone trainings to use and distribute contraceptives but were yet to be supplied with the contraceptives for distribution to the people.
This came out during a three- day fact finding mission in the district last week that was supported by the United Nations Population Fund (UNFPA) as part of commemorating the World Contraception Day, which was on 26 September 2022.
According to the UNFPA fact sheet, the first cohort of VHWs, were trained from 2019 on different contraceptive methods specifically on the newly introduced self-inject method called Sayanna Press.
However, following these trainings, VHWs have never been be supplied with family planning supplies such as oral contraceptive pills, condoms and Sayanna Press for distribution to women and young girls in their communities.
Distribution of contraceptives to the community was planned to go together with trainings to recipients, but according to the village health workers who spoke to this publication in Mokhotlong this has not happened to date.
‘Mareanetse Polihali from Ha-Ramonakalali area told Lesotho Express that her last training was in July 2021.
She said the training equipped her with family planning information, education and communication (IEC) materials which they were told to distribute after training.
“What is frustrating is that after our training I called a public gathering to inform the people about the new strategy of us distributing the commodities to them but I have never fulfilled that,” she said.
“It now appears as if I lied, but the truth is we have been disappointed by the people who are supposed to provide us with these contraceptives so that we can give them out.”
She said the unavailability of contraceptives from village health workers forces women and young girls to travel long distances or incur transport costs to get them from health centers.
Those who are unable to make the long trip are left at a high risk for unintended pregnancy.
“People were excited with the new arrangement as it was going to save them money and time to travel to Mapholaneng for their contraceptive supplies.
“Transport from here to the nearest Mapholaneng health centre is M70 return. Many people cannot afford it due to high employment in the area. I have to brew some traditional beer to sell to the communities in order to raise money for transport to get to the centre.”
Ms Polihali further added that the risk of unplanned pregnancies was amplified by the presence of Polihali Dam construction workers who targeted young girls and women to satisfy their sexual needs.
Another village worker, ‘Malehloka Lekhotsa, said long trips to the clinic also put women on a collision course with their husbands as they do not like contraceptives.
“You know the challenge with that is that some women clash with their husbands for travelling to get contraceptives at the clinic.
“Some women have to sneak to the health center without reporting to their husbands, and when they cannot be found, the husbands search for their hospital booklets, and when they can’t find them they know that they have gone to the clinic. But if the contraceptives were brought closer to them through us such challenges would be avoided.
She also said a neighboring Molumong Vocational school was battling a high rate of unplanned pregnancies in 2021.
“In the past year alone six students of Molumong Vocational School fell pregnant while in school.”
Ms Lekhotsa said the unintended pregnancies force girls to drop out of school, a thing that affects their growth and development.
She said there was an urgent need for the government to introduce and sustain supply of family planning commodities at the school to address this challenge.
Chieftainess of the area, ‘Mamojola Polihali, said the lifestyle of many women and young girls in her community, is worrisome and this has been since the beginning of the construction project.
Ms Polihali said young women and girls come up with excuses of needing to charge their cell-phones in order to meet the construction men.
“The presence of security officers in the village is also not helping as they too prey on the girls within the community,” Ms Polihali said.
“We are very concerned and we fear more pregnancies and early marriages are going to worsen.”
Mokhotlong District Administrator, Serame Linake, said there was a high number of school drop-outs due to early and unintended pregnancies in several areas especially in the Bobatsi constituency.
According to the 2017 United Nations Education, Scientific and Cultural Organization (UNESCO) report, Lesotho is listed among the leading countries on early and unintended pregnancies. The report shows that six out of ten girls which is 60 percent aged 15 to 19 years are young mothers or pregnant with their first child, which puts Lesotho second after Namibia with high rates of unintended pregnancies among the East and Southern African countries.
Mr Linake adds, “We have a high number of school drop-outs which is about 29 from high schools and secondary schools in Mokhotlong due to early and unintended pregnancy.”
“I will be able to provide more numbers as soon as the Ministry of Education completes their filing, but the school drop-out is very worrying,” Mr Linake said.
On whether education about contraceptives was provided to scholars Mr Linake responded: “Through the District Child Protection Team (DCPT), the Ministry of Health is a partner, and therefore provides health education programs through public gatherings and workshops about family planning to prevent EUPs. Part of them understands it very well.”
“However, our cultural believes and norms are a hindrance for some members of the community to accept them. I remember a time when we went to Tlhanyaku area with one organization for a public gathering, and old men in that area went on about how they could not talk about condoms in the presence of their daughters-in-law. What I believe needs to be done is to double up on health education strategies.”
On her part, UNFPA’s Sexual and Reproductive Health and Rights Co-ordinator, Blandina Motaung, said it was UNPFA’s responsibility working with the government to ensure universal access to family planning services.
On the challenge of lack of contraceptive supplies for village workers, Ms Blandina said it was an issue they would look into when they visit the district.
She added it was the community’s right to demand services. She said it was good for journalists to have been part of the fact finding mission to get the real picture of what is on the ground.
“Ideally, village health workers should be receiving family planning commodities from the health facilities that serve them within the catchment area where they are.
“In cases where they are under the Roman Catholic Church Facilities they are supposed to receive commodities from the District Health Management Team (DHMT).
“Having gathered this information, we will discuss it with the district this week on the issue of family planning data and its quality. I know definitely that this is an issue we will be able to address with the DHMT.
She further said there was a need to popularize other contraceptive methods such as the Sayanna Press, which is convenient for people who live in remote areas such as Mokhotlong. She said they have realized they might have rushed its introduction without educating the community more.
“We need to popularize and educate the community and generate the demand,” Ms Blandina said.