Idda (center) during a visit to Nowelia’s home in Ikukwa Ward, Mbeya District, Tanzania.

Nowelia Aron Malo had just given birth to her eighth child when she met Martin Idda Mkolwe at the Ikukwa Health Centre in Mbeya District Council, Tanzania. Idda, a registered nurse at the health center, immediately noticed that the baby had a low birth weight and that Nowelia looked exhausted from an obstetric complication – postpartum hemorrhage. Idda shared:

 Women like Nowelia rarely visit a health facility for check-ups during pregnancy, opting to wait until they are due for childbirth. Health facilities are far off for most of them, some over 50 kilometers away, and most women cannot afford the cost of transportation.”

As a result, many women deliver babies with health issues, lacking the knowledge and resources for a safe pregnancy and delivery. Unfortunately, this is a common situation in the Mbeya region, where women frequently avoid seeking medical care during pregnancy. Idda further noted:

 Where there is no safe birthing knowledge or limited access to health facilities, expectant mothers often suffer alone.”

Nowelia’s story highlights the critical need to improve access to healthcare and education for women, empowering them to make informed reproductive health decisions to safeguard both their own and their children’s well-being. As Idda explained:

 Women may deliver a sickly child due to lack of information or fear in seeking help – or because cultural norms prohibit them from accessing information on family planning.”

According to Nowelia:

 Women and young girls in my community bear the burden of taking care of their children, yet the decision as to when and how many children to bear is many times left in the hands of the father.”

Living in poverty and relying on handouts from menial jobs, Nowelia struggles to care for her large family. Her husband, who also relies on menial jobs, refused to consider family planning, believing it went against their cultural norms. Cultural misinformation about family planning not only affects individual families but also harms the broader community.

This puts newborns at risk, with 46 deaths per 1,000 live births, as well as thousands of Tanzanian women who die each year from pregnancy-related complications. Tanzania ranks among the sub-Saharan African countries with the highest maternal mortality rates.

In 63 cities across Kenya, Uganda, and Tanzania, The Challenge Initiative (TCI) is supporting healthcare providers to engage with their communities and strengthen access to quality family planning programs. TCI’s support of the Mbeya District Council allowed healthcare providers like Idda to bring family planning services directly to the community through integrated outreaches.

These interventions reduce barriers and costs associated with traveling to health facilities by bringing services closer to the community, especially in areas where facilities are distant or where there are negative attitudes toward them. Idda commended TCI for helping to expand access to family planning services in hard-to-reach areas, sharing:

  When I met Nowelia and her family, I was moved by their living conditions. In the same house, Nowelia’s daughter, nearing graduation from high school, was married off early. The bride price was required to help her siblings and parents afford food on the table.”

Idda witnessed the deep impact of poverty, with Nowelia’s daughter barely able to finish her education. She observed:

 Involving our husbands during counseling is the only way we can change the plight of many women and young girls. Dispelling the myths requires a concerted effort, and in such patriarchal societies, effective solutions will only work if men are willing to listen and hear why family planning is important.”

After persistent counseling, Nowelia’s husband finally agreed to support her decision to use family planning. While this has not dramatically changed their situation, his single action sparked conversations throughout their community. Today, Nowelia’s husband participates in community dialogues, sharing what he learned from Idda about family planning.

Motivated by this progress, Idda has started dedicating time to visiting the community to talk directly with men about family planning. These sessions provide a space to address their concerns and fears. Though this work is challenging, Idda now hopes that men like Nowelia’s husband can become advocates for family planning and help prevent more unplanned pregnancies.