Lilongwe

Malawi / Lilongwe

OVERVIEW

In Malawi, there are various health care options available, especially in larger cities. However, there have been reported stockouts at some pharmacies and clinics.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In Malawi, you can purchase condoms and birth control pills at pharmacies without a prescription, and no screening from the pharmacist is required. However, for other forms of birth control, such as implants, injectables, and IUDs, you may need to directly visit a hospital or clinic to obtain them.

In the past decade, Malawi has seen an improvement in contraceptive access for women in the country. In 2015, about 58% of married women (ages 15 to 49) were using some form of modern contraception, which was a notable increase since 2010 (when 42% of women used modern contraception). This was also higher than the Eastern African average, where about 40% of women use any form of contraception. However, many women in Malawi still struggle to access contraception -- and, in fact, one in five married girls and women in Malawi want contraception but do not have access to it. It was estimated in 2015 that about 19% of women in Malawai have unmet family planning needs, which is lower than the Eastern African average (about 24% of women).

The most common forms of contraception in 2015 were found to be injectables (31% of women), female sterilization (10% of women), and implants (9% of women). There were low rates of usage for other contraceptive methods, such as oral contraceptives/birth control pills (2% of women), condoms (2% of women), and IUDs (1% of women), as well as traditional methods, such as the rhythm method (less than 1% of women) and withdrawal (less than 1% of women).

What to Get & Where to Get It

• While you can find condoms and pills at pharmacies, it may difficult to find contraceptive patches or rings (as of 2020).
• Marie Stopes International - Malawi: "We’ve been providing sexual and reproductive health services in Malawi since 1987. We provide long acting and permanent methods of contraception to women and men, in our clinics, through outreach and through our social franchising network. We measure our results using couple years of protection (CYP), a measure estimating the protection offered to a couple from using contraceptives during a one year period." Contact Details: Banja La Mtsogolo - Mpatsa House - Off Paul Kagame Road - P.O. Box 1854 - Lilongwe - Malawi - +265 01 772 497 / 498 - banja@banja.org.mw
• Mitch Pharmacy: They have an online form on their website, where you can get a quote for various products. They sell birth control pills, but they said contraceptive rings or patches weren't available when we asked (March 2020).

Costs

• The cost of birth control pills will vary, depending on where you go. If you go to an NGO, the pills may be free or reduced cost. If you go to a private pharmacy, you can expect to pay around MK1,350 per cycle of 28pills (as of March 2020).

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex to prevent pregnancy. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In Malawi, emergency contraceptive pills (morning after pills) are available over-the-counter at pharmacies. No prescription is required. In 2010, it was estimated that about 35% of women (of reproductive age) in Malawi had knowledge of emergency contraceptive options, and 0.7% of women (of reproductive age) in Malawi had ever used emergency contraceptive pills have ever used emergency contraceptive pills. For a report on emergency contraceptive use in Malawi, you can check out this report: COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION.

What to Get & Where to Get It

• You can find emergency contraceptive pills (morning after pills) at pharmacies, hospitals, clinics, or programs affiliated with the International Planned Parenthood Foundation. They are sold over-the-counter at pharmacies. Some brands you may find are Pregnon and Revoke 72.
• Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex. Check to see if your country carries ellaOne. If your country doesn't carry ellaOne, copper IUDs may also prevent pregnancy up to 5 days after unprotected sex. If none of these options are available, and it's been over 3 days since you had unprotected sex, you can still take EC, which may work up to 5 days. Note that EC pills are not 100% effective and should be taken as soon as possible.

Costs

• If you go to a government hospital or one of the Christian Health Association Hospitals, you should be able to obtain the emergency contraceptive pill for no cost.
• If you go a pharmacy, you can expect to pay around MWK 882 to MWK 1,323, as of 2015.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

In Malawi, there are no known travel or residency restrictions for people with HIV/AIDS. This means that you can enter the country, regardless of your HIV status, and you should not be deported if you test positive for HIV while you are in the country.

Generally speaking, Malawi has a high HIV infection rate. In 2018, 1 million people living with HIV in Malawi, which was 9.2% of the adult population (ages 15-49). There were 38,000 new infections per year and 13,000 AIDS-related deaths per year. In terms of treatment, 79% of adults and 61% of children with HIV were on antiretroviral treatment.

Despite these high numbers, there are various programs that focus on the treatment and prevention of HIV. The new infection rate has dramatically declined, going from 66,000 infections per year in 2005 to 38,000 infections per year in 2018. Furthermore, an estimated 90% of people living with HIV in 2018 were aware of their status.

There are some initiatives to help sex workers access STI tests, prevention, treatment, and counseling in Malawi. To learn more about this work, you can read this report from Doctors without Borders: The sex workers on the frontlines of the HIV response.

Testing Facilities

• Banja La Mtsogolo (Marie Stopes Malawi): "Our programme in Malawi, called Banja La Mtsogolo, was established in 1987 to address the country's high maternal mortality and unsafe abortion rates, while combating HIV/AIDs and poor sexual health." Phone: +265 01 873 240. Email: banja@banja.org.mw
• PSI Malawi: "PSI/Malawi’s portfolio includes a range of products and services to include HIV self-testing, voluntary medical male circumcision, water-borne disease prevention, malaria prevention, male condoms (Chishango), female condoms (Care and Whisper), family planning services and products (Safe Plan) and Tunza franchise clinics." Phone: +265 (0) 1711484. Phone: +265(0) 1711487. Phone: +265 (0) 1711488

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

Gynecological Exams

What to Get & Where to Get It

• Daeyang Luke Hospital: This private hospital is supposed to be one of the better medical centers in Malawi. Be aware that this is a faith-based hospital. Phone: +265 1 711 398
• Medical Aid Society of Malawi Clinic: Phone: +265 1 794 266
• Good Hope Private Clinic: Phone: +265 997 69 16 06
• Likuni Mission Hospital: According to Lonely Planet, " A better option than Lilongwe Central Hospital, this hospital, 7km southwest of Old Town, has public wards, private rooms and some expat European doctors on staff."

Pregnancy

Laws & Social Stigmas

The maternal mortality rate (MMR) is 634 deaths per 100,000 live births, according to 2015 data. This MMR is ranked 13th in the world, which means that Malawi has a significant maternal mortality problem.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In Malawi, abortion is only legally permitted to save the life of a pregnant person. If someone is caught trying to obtain an illegal abortion, they can face seven to fourteen years in prison. If someone helps procure drugs or medication for an illegal abortion, they can face up to three years in prison.

There is a large underground, clandestine abortion scene in Malawi, as in many other countries that have restrictive abortion laws. In Malawi, it is common for women to turn to traditional healers for abortions. However, these abortion providers may be unsafe or improperly trained, and women die in Malawi every year due to these clandestine abortion providers. It is estimated that 6-18% of maternal deaths in Malawi are due to unsafe abortions.. Furthermore, approximately one third of women who experienced complications from abortions did not seek out the help that they needed.

The current abortion laws are actually quite old. They were put in place in 1861, under section 243 of the penal code. These abortion laws are largely preserved because of the religious orientation of the country. About 81% of the population is Christian, and many Christians oppose changes to the abortion laws.

What to Get & Where to Get It

• Aunty Jane Hotline gives sexual and reproductive health information, including information on the safe use of Misoprostol (one part of the abortion pill). The hotline can be reached at: (+265) (0) 884 773 300 or text (0) 884 773 310.
• "Misoprostol is available under the brand names Misoprost and Isovent." - Women on Waves
• Abortion services are provided in clinics from Banja la Mtsogolo (BLM), which are a part of Marie Stopes International.

Advocacy & Counseling

• Aunty Jane Hotline gives sexual and reproductive health information, including information on the safe use of Misoprostol (one part of the abortion pill). The hotline can be reached at: (+265) (0) 884 773 300 or text (0) 884 773 310.

LGBTQ+ Resources

• Equaldex - Malawi: Click here to learn about LGBTQ rights and laws in Malawi. It is important to understand that homosexuality is illegal in Malawi, as of December 2018.
• LGBT Travel - Malawi: This website provides information on LGBTQ+ travel and what this means for people who may want to visit Malawi.
• Human Rights Watch - Malawi: Arrests, Violence against LGBT People: This report provides some background on persecution experienced by LGBTQ+ people in Malawi.

Additional Resources

• Ministry of Health (MOH) - Malawi
• Family Planning Association of Malawi: "When it was founded in 1999, the Family Planning Association of Malawi (FPAM) focused on providing family planning services. As the organization has evolved, it has both refined and expanded its operation. Today, FPAM targets young people primarily, and reaches out to under-served rural communities. As a result, it operates 64 service points, including 53 mobile sexual and reproductive health (SRH) facilities and 4 static clinics. Its community-based distributor/services (CBDs/CBSs) profile is also very strong with 65 additional delivery points. As ever with IPPF Member Associations, the mix of outlets and approaches is very much led by the particular demographic and geographic needs of the country."
• Family Planning Malawi 2020: "FP2020 works with governments, civil society, multilateral organizations, donors, the private sector, and the research and development community to enable 120 million more women and girls to use contraceptives by 2020."
• USAID - Malawi Family Planning & Reproductive Health Fact Sheet: "USAID collaborates with development partners and civil society to address rapid population growth, which remains a significant development challenge in Malawi."