When a Malawi newly born child is denied health services for mother’s ‘sins’

 At three months, baby Luciano (not real name) has not received any vaccine since birth as his parents are yet to pay fines for breaking safe motherhood bylaws instituted in their area.

Newly born babies are supposed to receive Bacille Calmette-Guerin (BCG) at birth, Diphtheria (DPT) 1 and Pneumococcal Conjugate Vaccine (PCV) 1 at six weeks and DPT 2 and PCV 2 at 10 weeks which protect them against TB, Diphtheria, Tetanus and Pertussis as well as Pneumonia.

Immunization against the diseases is according to World Health Organization (WHO) standards and recommended for all newly born babies.

However, this is not the case with baby Luciano of Kaukutu Village in the area of Senior Chief Nyambi in Machinga District.

His mother, Susan Wyson, 28, cannot access health services at Nyambi Health Centre where she contravened Safe Motherhood Bylaws that were put in place by local authorities.

This was the genesis that triggered the vicious cycle that has seen baby Luciano shouldering the price of his parents’ ‘sins.’

Currently, Luciano’s life is under threat considering that he has not been immunized against any of the diseases that the early vaccines protect one against for their lifetime.

“I went to the health centre with my husband when I was two months pregnant but I was sent back because the pregnancy tested negative; however, we were told to go back after three months.

“Unfortunately, I went back to the health center after four months and I was told that I had contravened the safe motherhood bylaw that stipulates that one has to start antenatal visits at three months hence was told to pay K3, 000,” Wyson says.

She says they [with her husband] failed to pay the fine because they could not afford it and the health personnel confiscated her health passport.

However, despite the seizure of the health passport, Wyson continued to go for antenatal and on June 16 she was given an appointment of July 10 as her due date.

Ironically, Wyson went into labour on June 30 and left home for the health centre. Unfortunately, she did not make it to the clinic and ended up delivering outside hospital premises.

“When we reached the clinic the nurses started shouting at me for not giving birth at the hospital. Another K5, 000 penalty was imposed on me in line with the set bylaws, bringing the figure to K8, 000.

Meanwhile, she says her health passport is still at Nyambi Health Centre and the baby has not gotten any as well.

I have never attended any postnatal clinic as on top of the K8, 000, I am supposed to pay an extra K2, 000 every visit because the bylaws require babies born at home to pay that amount to access postnatal service,” she says.

So far, baby Luciano has fallen sick once with cough and flu.

Senior Chief Nyambi confirmed to have set the bylaws with the chiefs in the area in order to reduce cases of maternal death in the area.

“We sat over this issue with the concerned parties including medical personnel at the facility and we reached a conclusion but I am not aware that the baby is not getting any postnatal services from the hospital,” Nyambi says.

Nyambi says most women were delivering their babies outside clinics which saw a number of preventable maternal and neonatal deaths taking place in the district.

Hospital Advisory Committee (HAC) Treasurer at Nyambi Health Centre, Samson Manyowa, says they received reports about Wyson and were making arrangements to visit the area and meet the chief and concerned parties.

“During our meeting where Senior Chief Nyambi was briefing us together with the medical workers from the centre, the committee raised the issue of poor people who cannot manage to pay the fines.

“The medical workers at the centre assured us that they will be offering them [those that cannot afford to pay] the services while they are servicing their debts arguing that removing the fines or penalties will result into women giving birth at home anyhow,” Manyowa says.

Machinga District Health Office (DHO) Public Relations Officer (PRO), Clifton Ngozo, says he is aware that people pay fines for breaking bylaws but stated that the fine is K3, 000.

He, however, says Wyson’s issue never came to their attention and will investigate to see if the woman and her baby are failing to access postnatal care due to unpaid fine.

“This has just come to our attention and we will investigate the matter to see if the woman is, indeed, being denied services because of the fines,” Ngozo says.

Ministry of Health spokesperson Adrian Chikumbe says in line with the Universal Access to Health Care concept by World Health Organization (WHO), no health facility has the right to deny services to mothers and their babies.

“This means even after failing to pay fines, women and their babies are not supposed to be denied health services but rather the women just need to be advised accordingly on the need to follow the bylaws,” he says.

Malawi Health Equity Network (MHEN) Executive Director, George Jobe, feels the penalties stipulated in the bylaws should include non-monetary aspects such as community work for those with limited financial resources.

“In this case, we may lose the baby or the mother because they are not accessing postnatal health care.

“The local leaders should consider giving community work as a punishment to those who cannot afford to pay a fine under the bylaws,” Jobe says.

According to the Ministry of Health’s Road Map for Accelerating the Reduction of Maternal and Neonatal Mortality and Morbidity in Malawi (2005), the country registers the highest number of deaths of infants globally.

Currently, it is estimated that 1120 infants out of 100,000 live births die during the first 28 days. This is an increase from 620 per 100,000 live births in 1992.

Indeed desperate times call for desperate measures hence the community bylaws. But should the country lose baby Luciano and, possibly, increase further neonatal mortality because of the by-laws?

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