Family Planning, Financing and Aid Effectiveness

Kulera = Happy, Healthy Family

Golden Makoka is a 30-year-old taxi driver in Malawi’s capital city, Lilongwe. He and his wife have one child, and one more on the way. They only want two to three children, so they can provide for them properly. “I hope I can have a small family,” he says. “My children (will) need a lot of help from me as their father. With a small family, I can take care of them with school fees, food, clothing, and other necessities.”

To ensure this happy, healthy life, the Makokas rely on kulera, which is the Chichewa word for family planning. Golden says that they are very committed to having a small family. He recalls a time when the government clinic his wife relies on for Depo Provera, an injectable contraceptive, was stocked out. Fortunately his wife was able to get Depo from Banja la Mtsogolo, a popular private provider. “We cannot give up (accessing family planning),” he says, “because at the end we would have lots of kids instead of two or three.”

By Malawian standards, the Makokas will have a small family. Most Malawian women give birth to almost six children in their lifetime, although the typical desired family size is four. Women living in cities have better access to family planning services, and on average have only four children. Malawi’s high overall fertility rate is due in part due to unplanned pregnancies, which have contributed one of the highest maternal mortality ratios in the world.

The author with Golden Makoka in Lilongwe, Malawi.
The author with Golden Makoka in Lilongwe, Malawi.

It is no wonder that Golden wants a small family. Growing up outside Zomba, he saw neighbors struggling with larger families. Unable to feed and clothe their own kids, they would knock on his parents’ door asking for help. Golden already works six days a week up to 12 hours a day, often at odd hours, just to provide for his wife and son. I should know—he spent the last week driving me and my colleagues around the city.

I am in Lilongwe to learn more about the budget line for contraceptives that Malawi’s government funded in 2013/14, when female Members of Parliament (supported by the Health Policy Project) refused to pass the budget without an allocation to contraceptives from the government’s own funds. As a result, this year there is 26 million Malawi kwacha (U.S. $80,000) committed to contraceptives. But getting the budget line funded was not enough: the government was not spending the money. The same parliamentarians convened a hearing earlier this year on the status of the budget line. Now the Department of Reproductive Health has issued a procurement order, and requested an increase in the budget line for the next fiscal year to 60 million kwacha. The increase still has to be approved by the Ministry of Health and Parliament.

Eternal vigilance is the price of a budget allocation for contraceptives. I’m happy to announce that PAI has issued a Request for Proposals to support a civil society organization in Malawi to advance the great work of the parliamentary coalition, and engage with the Malawian government to make sure the budget line is spent and continues to increase. This work is part of RH BudgetWatch, a project that seeks to increase funding allocations and expenditures for contraceptives; and foster a strong community of professionals involved in budget analysis and advocacy for reproductive health.

The Malawian government cannot continue to rely on donors to fund 100 percent of contraceptives—that is unsustainable. The fact that the government spent its budget for contraceptives this fiscal year is a great step in the right direction. But more work needs to be done to support Malawian couples like the Makokas to have the number of children that they can actually provide for, without reliance on foreign aid.

Note to the reader: Suzanna is writing from Lilongwe, Malawi. Golden Makoka did not receive any financial support for his interview or photograph for this blog. 

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