Some commercial sex workers (CSW) in the country have complained that health workers in certain district hospitals are administering contraceptives on them without their consent.
Malawi News investigations can reveal that the need to control incessant population growth in the country is forcing health workers to administer family planning injections to CSWs when they seek medical attention for different ailments.
Our investigations show that this practice is happening mainly in lakeshore and border districts of Mangochi, Salima, Nkhata Bay, Mwanza, Mchinji and others with high numbers of CSWs and main targets are those who have several children.
Donattah Kassim, a 27-year-old CSW plying her trade at Salima boma, told Malawi News that she stopped having her menstrual cycles in June last year after she had gone to Salima District Hospital to seek medical attention for a Sexually Transmitted Infection (STI) she had contracted.
“I suspect that the nurses at the hospital injected some contraception drugs in me; my fears were confirmed when my friend also complained of the same,” she said.
Kassim said over seven months have now elapsed since she had her menstruation and that she is gaining weight.
“I have also developed high blood pressure and I am no longer active,” she said.
Another sex worker who has faced the same ordeal is 33 year-old Annie Twayb who is also a mother of four.
She disclosed that she was told by a nurse at Mangochi District Hospital that she would be given an injectable contraceptive when she went to receive medicine for the syphilis she had contracted.
“She told me that I had too many children and that it would be good if I considered taking up family planning methods. I tried to resist, but I was threatened that they would not give me medicine for the syphilis. I feel bad because I am no longer the strong person I used to be and I no longer have appetite for sexual intercourse,” she said.
Asked why she finds herself pregnant frequently, Twayb revealed that it is due to unprotected sex.
“I don’t use condoms consistently, but when I do I mostly experience condom bursts. Most times I accept more money in exchange for plain sex and I can’t refuse because if I do so my client would go to another woman or even beat me up,” she said.
A nurse-midwife based in Salima, who spoke on condition of anonymity, confirmed that the practice indeed takes place.
“There are strong messages by organisations on correct and consistent use of condoms, but it would appear this is not being adhered to by CSWs as a result they are getting unintended pregnancies,” said the health worker.
The health practitioner said the unfortunate part was that when they deliver they dump the babies at the homes of their impoverished parents.
“So, we use what I would call provider initiated intervention to tame a would-be crisis,” said the practitioner.
He said although Mangochi and other Lakeshore districts have achieved impressive gains in contraceptive uptake, health workers still have problems with sex workers.
“Sometimes we can inject double dosages so that the period that the medicine works in their bodies lengthens. We know this may be unacceptable, but as people on the ground we feel this is the way to go and I can assure you this is happening in many hospitals across the country,” said the nurse.
Ministry of Health spokesperson, Adrian Chikumbe, said the ministry considers family planning AS a human rights issue and that a health care worker’s job is to advise and guide a client on the best method based on that person’s health.
“Our personnel is supposed to advise on the available methods, but not force anyone to uptake them or administer them without their consent,” he said.
“Much as I know the medical workers practising this might have agreed to do so owing to the pressure they get on the ground, I must emphasise that it’s not acceptable and once found they will face the consequences,” he added.
Chikumbe, however, said this practice is to a certain extent acceptable in HIV/Aids where there’s Provider Initiated Testing and Counselling so that they best help the patient, but that should not be applied to family planning.
Maziko Matemba, Executive Director of the Health and Rights Education Programme (HREP), described the development as shocking and advised health workers not to take advantage of people’s ignorance to administer medical procedures on patients without seeking their authorisation.
“I would urge the Medical Council of Malawi (MCM) to intervene because this is unethical. It’s unacceptable and people need to be aware that this is happening and in addition they must know that they are at liberty to deny medication if they feel so,” he said.
Matemba then urged those affected to consider suing the health personnel involved.
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