…a submissive wife tells a tale of how her husband’s passing liberated her sexual and health reproductive rights from tyranny of mother-in-law.
Nthabiseng Hlasoa* aged 28 of Ha-Masupha in the Machache constituency is getting ready to leave Nazareth Health Centre after her weekly appointment at the centre.
She is among hundreds of nursing mothers who access health services at the centre.
Despite being situated some 3KM away from her village, she prefers services offered at health centre which she says are better.
Hlasoa is a mother to a 10 months’ baby boy, her second child.
Her gloomy face is that of a happy new mother who is determined to raise her child within the bounds of good health care.
She smiles when telling this reporter, she had to stop using injection family planning method to conceive her bundle of joy.
“My partner and I are devoted on using a condom now that I’m a nursing mother. Soon after I nursing my baby I think I will go back to using contraceptives pills although I have problems with their side effects,” she says.
Hlasoa is among many women in Lesotho who use contraceptives catered for by the system.
Her uncertainty however puts her under the 18 percent of women with unmet contraceptives needs.
Living with HIV and in the remote village of Ha-Masupha, Hlasoa tells this reporter she first had a child at tender age of 21. She was then hurriedly married off after discovering of her pregnancy.
Not ready and without any knowledge of what marriage entailed, she abided by her parents’ conclusion and was married to her older male companion.
She described her relationship with her deceased husband as pressured and under duress.
“I was a child and inexperienced about what sex is or how best to protect myself with the use of contraceptive methods. We were in a relationship but I can’t really say I loved him; I was scared of him and every time he demanded to have sex I let him do as he pleased,” she says recalling her submissive love story.
With sorrow filled eyes, Hlasoa recalls how her first induction as a daughter-in-law changed her life and vision of life. She further reminisce how her obliviousness about her sexuality deprived her off her essential sexual and reproductive health rights as a woman.
“He had a job, so that made it easy for my parents to just push me over to his family. I was their burden. My mother-in-law had me confined to her dictates alone and refused me access to antenatal clinic services arguing only traditional remedies were a culture in her household,” Hlasoa says narrating the ordeal newlywed women in Lesotho undergo at the hands of their mothers-in-law.
Hlasoa, with teary eyes, says despite efforts by elderly women in her village to get her mother-in-law to change her mind, there was no winning.
“I started my clinic sessions when 8 months late and I managed to go my delivery time. I was unfortunate that my child only lived for three days.
“It was sheer luck that I gave birth in a health facility given how hard headed my mother-in-law was. After I lost the baby, grieving as I was, I was blamed and endured all different kinds of abuse from her and my husband.
“He never protected me from his mother, he never supported the idea of my attending clinic sessions but when the child died it was my doing,” her emotional voice recounted.
She adds, “After losing my baby girl, I asked the nurses to help me prevent any possibilities of me ever having a baby while still living with that man, it would be my own secret.
“The downside to my need for contraceptives was that the clinic nearby was a church (Roman Catholic Church) owned and thus access to any methods of family planning was not possible. However once a month at the time, the ministry of health had monthly visits closer to my village and among services accessible were family planning services.
“Not very sustainable but they worked whenever I got a hold of them. I succeeded to conceal my use of contraceptives from both my husband and my mother-in-law but, God knows, I hated the side effects, but I wanted to find a way out of the marriage and regain the power of my life back so I remained true”.
Despite the median birth interval in Lesotho being 45.8 months with 11 percent of all children born within 24 months of a previous birth according to the country’s Demographic and Health Survey (LDHS) of 2014, Hlasoa’s decision to prolong her ability to give birth was socially and culturally related.
Having dropped out of primary school when she discovered her pregnancy, her desire for sexual reproductive freedom from a marriage she described as oppressive drove her to access birth control services that the country is looking to scale up for more women.
While one out of every five times or 22 percent of women who began using a contraceptive method in the last 5 years before the survey, discontinued their use of the contraceptives method in less than 12 months due to reasons that includes side effects, Hlasoa was among the 16 percent who decided to stop due to the desire to fall pregnant again.
According to the United Nations Populations Fund, (UNFPA) the availability of family planning services allow individuals to achieve: “desired birth spacing and family size and contributes to improved health outcomes for infants, children, women, and families”.
“Contraceptives prevent unintended pregnancies, reduce the number of abortions, and lower the incidence of death and disability related to complications of pregnancy and childbirth,” UNFPA says.
Hlasoa’s decision helped her evade her mother-in-law’s oppressive norms that barred her from accessing antenatal care health services while pregnant and allowed her to mourn untimely passing of her baby.
Her baby’s passing forms part of the soaring statistics of 80.2 per 100,000 live births of under-five (5) mortality rates according to the 2016 Lesotho Census.
“It was four years ago when my husband died that I learned of my HIV status. I had stopped using contraceptives and we had sex regularly.”
“His death was the beginning of my life because I left Lesotho to seek employment in South Africa, met my current partner who is loving and supportive,” she recounts with a smile.
She notes her new partner encourages her use of contraceptives so that they do not conceive an unplanned baby.
“I was a maid but had to leave work due to pregnancy, he works at a construction company so he is always busy, hence his suggestion that I consider using contraceptives,” Hlasoa said.
The UNFPA Country Representative Nuzhat Ehsan addressing a group of journalists in Maseru last week noted issues of Sexual and reproductive health and rights, family planning and gender based violence were pertinent to the organisation.
“These issues are pertinent to us as UNFPA, the United Nations Population Fund as they are about safeguarding the lives of Basotho.
“They are also going to be extensively addressed in the five-year programme of assistance between UNFPA and the Government of the Kingdom of Lesotho beginning 2019.
“In this programme, which is aligned with the 2030 agenda – the Sustainable Development Goals — particularly Goals 3, 4 and 5 on health, education and gender respectively, and guided by the International Conference on Population and Development (ICPD), we will strive to achieve three transformative results; ending preventable maternal deaths, ending unmet need for family planning and ending gender based violence and harmful practices such as child marriage,” she said.
She added that the UNFPA was concerned by the high rates of maternal mortality which according to the survey notes that the ratio is 1024 per 100 000 live births.
“Most of these deaths can be prevented. We believe one of the ways to prevent these deaths can be the use of family planning so that women can have planned and wanted pregnancies.
“Through family planning, people make children by choice not by chance, meaning they can plan when to have children and how many children to have. The unmet demand for family planning services in Lesotho is currently at 18 percent. This also is too high,” Ehsan said.
Access to primary level of health care according to the National Health Strategic Plan (NHSP) 2017-2022 includes health centres, health posts and all community level initiatives including all staff working at this level.
“There is a network of more than 6,000 village health workers who work at the health posts and a Village Health Worker serves about 40 households. There are also other categories of community-based health workers such as traditional birth attendants, community based condom distribution agents and water minders,” the strategic plan provides that this Village Health Workers are volunteers who also receive incentives from government.
“They mainly provide promotive, preventive and rehabilitative care. They also organise health education gatherings and immunization efforts within the communities they serve,” reads part of the strategic plan.
It continues that the link between community and health centres provided for by Village Health Workers has remained informal despite their huge contribution.
“They refer cases to health centres which are the first point of professional care. Nurses at health centres supervise and train VHWs. Health centres offer curative and preventative services, including immunisations, family planning, HIV/AIDS and TB treatment and deliveries.
“There is a health centre committee made up of representatives from the communities they serve including chiefs and opinion leaders with the head of the health centre being a member. Each of the Local Community Councils has a Social Services’ Committee.
“Family planning is a fundamental right and the National Health Policy of Lesotho requires access to family planning services for all those who need it.
“Family planning services are provided by all health facilities at all levels of care except for facilities owned by the Roman Catholic Church,” the strategic plan stresses adding that provision of Family Planning services has been integrated into sexual and reproductive health and HIV and AIDS services.
“The main Family Planning methods most utilized by the population are the pill, the IUD, condom (male and female), depo vera, injectables and implants and among the main challenges faced by the Family Planning programme are funding and frequent stock-outs of Family Planning commodities.
In 2014, a survey was conducted to assess availability of modern conceptive methods and lifesaving medicines. The survey reported that condoms (both male and females), oral contraceptives, injectable, and emergency contraceptives were available in 80% of health facilities.
This study also identified stock-out of at least one modern contraceptive at primary level service delivery points (SDPs),” the strategic plan highlighted.
Despite the challenges outlined by the strategic plan, ensuring equity in access to health services, infrastructure, equipment and technologies for quality primary and secondary health services for all Basotho are identified as strategic objectives with access to safe, effective, affordable and acceptable reproductive health services including family planning services to youth, women and men as key areas.