If you really want to fight the patriarchy, if you want to make a difference in girls’ lives, you have to reach them when they are young, says Joyce Banda.

The former president of Malawi recently spoke to Roger-Mark De Souza about her work in Washington as a distinguished fellow at the Wilson Center and Center for Global Development. She had more to say, though, and we sat down for a wide-ranging discussion that we recorded, transcribed, and lightly edited for space.

President Banda elaborates on four core issues: her own unique life experience, her passion for maternal health, how she appealed to tradition while enacting change, and why reaching girls before they turn 10 is so important. 

On life experience informing her advocacy…

My public life was 10 years long. My main path now is getting income into the poor households so the girl child can go to school and bringing more attention to the experience of very young girls.

I have been very fortunate in my life that I have championed issues that originate from personal experience. I was born in a village in Malawi, in a tribe that is matrilineal, and I was supposed to be brought up by my grandmother. My father had just started working in the Malawi police band as a musician and he insisted that he wanted to bring me up. My grandmother had the right to and she compromised that I’d be in town five days, go to school, and then come back to the village 15 kilometers away to be with her on the weekend.

Every Friday when I came back from school, I would have a friend by the roadside waiting for me by the name of Chrissie. She was my best friend in the village. She taught me all about village life, and I told her what I was learning in town. We were both selected to the best girls’ secondary schools in the country. Chrissie went to St. Mary’s, I went to Providence. But when I came back one holiday, Chrissie was not by the roadside. My grandmother told me that she wasn’t going to come anymore because the family had failed to raise the six dollars required to go back to school. Chrissie got married at 15, ended up having a child early, and that child died of AIDS.

So it was at 14-years-old when I came face-to-face with the injustice of this world, that when there’s no income into the household, the girl child is the first victim. Chrissie was brighter than me, and yet I ended up here instead of her. That it is not fair. It is that experience that led me to do more research and advocacy on the issue. Some 60 million children can’t go to school around the world and it may be as many as 90 million.

I was at an age when I couldn’t do anything about Chrissie, but I can now. I have sent 3,500 girls to school and built schools for them. The good news is that I managed to get Chrissie back to work with me. Now she’s a champion that goes about looking for girls that need education. She met Gordon Brown, who was the UN special envoy for global education, in New York three years ago and even Bill Clinton.

On maternal health…

In 1984, I went to have my fourth-born child in January and suffered post-partum hemorrhage. This is the biggest killer for pregnant women in my country because most of them have no access to medical expertise. They are delivering with a traditional birth attendant, they start bleeding, and this traditional birth attendant is ill-prepared and ill-trained for this and can only sit by and watch the woman die. I suffered post-partum hemorrhage and my husband, who was then a high-powered judge, he went and found a good friend of his who was one of only three gynecologists in the country, and he saved my life.

When I woke up, I started asking questions about what was happening to other women who were not as fortunate as myself. It is not acceptable that a woman should die giving life. Here in the West, when a woman is pregnant, it’s a time of joy, it’s a time of expectation, you start to shop for baby things, you even know the sex of the child! Where I come from, it’s a time of anxiety, because you don’t know whether the woman is going to come back.

In one incident, the African Union had appointed me goodwill ambassador for safe motherhood and I was visiting a rural hospital 43 kilometers from the next referral hospital. I got there, and they told me one baby had been born that night. Everybody that knows me in Malawi knows I hug a lot, so I’m running into the ward to hug this woman and to hold the baby, and I find her with tears streaming looking at me and I said, “Where’s the baby?” and she said, “I don’t have a baby.”

She had come to the hospital, walked 15 kilometers, but the requirement in that particular clinic was that they must bring a candle in case they deliver in the night because there’s no electricity. So when she didn’t have the 50 cents, the five cents, or whatever that she needed to buy a candle and came without, they had to deliver in the dark. She and the nurse struggled, and the child had the umbilical cord around its neck and couldn’t survive.

Now this is a woman who doesn’t know her rights, she didn’t know that this is unacceptable, unfair, and that is another problem. But I decided, when I get an opportunity, I’ll do more for women. To cut a long story short, it was as simple as me going to a company, appealing to their social corporate responsibility, and saying, “Help us with electricity, can you put electricity in that clinic?” Four weeks later, I was back to switch on the lights.

On balancing tradition with change…

In Malawi, 85 percent of people are rural-based and the traditional hierarchy of chiefs is very powerful. The moment a chief says anything in his jurisdiction, that’s what everybody shall do. So when I became president, what I did was to mobilize the chiefs, who are normally men and are not known to associate with childbirth. For the first time, I told them that they are champions and if there is any woman dying in their village, it is their fault, that they can stop it.

I invited all the paramount and traditional chiefs in the country – there are about 500 – to a meeting. I told them, you shall assist me to send as many girls as possible to school, you shall assist me to improve nutrition at the household level, dietary diversification – it’s all in your hands. But let’s start with this unnecessary death because I know you can do it, you can help me reduce this.

And I increased their salaries, because they are paid by the government, and made their roles more visible. We needed the chiefs to be engaged and to be convinced that it was the right way to go and to know that the whole head of state and the government respects them and the power they hold. If I came to the U.S., to the U.N., I brought them with me. People would see a chief in his robes getting onto the plane with me and see that they are part of the country’s movement toward achieving social development.

The men in the community saw the chiefs championing maternal health and they also became inspired and motivated. The chiefs told them that real men get involved in their wives’ pregnancy, real men go to the hospital with their wife, real men will find a bicycle to take their wife to the hospital so she doesn’t have to walk. And we also started a training program of community nurses who would become midwives and agree to come back and live in a community.

What happened very quickly was that now congestion was the challenge at the small clinics because everybody went. In fact, we turned the traditional birth attendants into a referral service. The women in the village could go to the same traditional birth attendant and say, “I think I’m in labor” or “I’m pregnant.” In the past, because of the taboos that surround pregnancy, you could only talk to your mother or mother-in-law, but the chiefs said you can also talk to the birth attendant. So this became a critical group of “secret mothers,” who the women could talk to, and we also made men feel like part of the solution.  

In 24 months, we were able to reduce maternal deaths from 675 women per 100,000 live births to 460, a reduction of 30 percent. It is not good enough, but it gave me the belief that we can eradicate this unnecessary death, that women don’t need to die.

On reaching young girls…

Everybody is keen to achieve the Sustainable Development Goals, and there is tremendous focus on reaching adolescent girls, age 10 to 14. The girls must go to school, must have uniforms, must have pencils, must have toilets, sanitary pads, and things like that. As far as the supply side is concerned, I want to commend all the players who have been supporting adolescent girls for the work they have done. But in my opinion, as an African woman leader, this is not good enough, we need to focus more on the demand side.

What happens to a girl child in a typical a rural setting between zero and nine can leave permanent scars for the rest of her life. If you wait until she’s 10, it’s already too late. My concern is to make sure that the family sees the need to send their girl to school and are inspired to do it, and the girl feels it too.

It starts from the day she’s born. This is a family that was expecting, hoping for a boy child. There’s so much pressure to have a son. Children begin to be socialized at the household level immediately. The girl child living in the village, she and her mother don’t sit with the men and boys; they cook food and deliver it to them under the tree. The boys are with their fathers and get the best food. The girls eat with their mothers, who despite doing the growing, harvesting, storing, processing, and cooking, eat last and least. It all affects the nutritional content of what the boy child and girl child are eating and early brain development.

And then there are more noticeable physical effects. By five years old, girls are carrying heavy loads on our heads. It was 1995, and I was having an operation when the doctor told me, “I hope you have been informed before that your back, your spine is bent.” Last year, here in America, I went back to see an orthopedic because I was having hip pains, and I thought I needed a hip replacement. Many x-rays were done. Finally, they told me I was likely injured when I was very young carrying heavy loads. Even with a working father, I ended up a victim of that. I don’t know how many thousands of girls and women in Africa walk around deformed because they have been working too much at an early age.

The other way very young girls are affected is harmful traditions like “cleansing,” trokosi, sexual initiation, and child marriage. It’s believed by some adult men in Malawi and elsewhere that when you defile a five-year-old, a four-year-old, then you cleanse yourself of HIV/AIDS. In the trokosi practice of parts of Togo, Benin, and Ghana, girls ages 6 to 10 given as slaves to shrines to forgive a family offense. Some girls are married at five, others get cut and publically mutilated at age 10. Some Malawian girls are forced to sleep with adult men after their first menstruation cycle.

How can we expect girls to have an equal opportunity when they have gone through so much before the age of 10 – starved, cut, defiled, married without consent, pulled from school? Don’t tell me that if we start focusing on these girls at 10, they’re going to be okay. It’s all connected.

The household must have income so the girls can go to school. The girls must go to school so that they don’t get married at 10. But the girls also need to be supported as equals in every way, from day one.

I know that it can work. I truly believe that it can be done. In my time in the statehouse, I learned that people will listen to you, even the very poorest. You must engage people, their local leadership, get them on board. We need their partnership and support. I believe that leadership is a love affair: you fall in love with the people, and the people fall in love with you. The best you can do is to engage the people, build consensus, and have the courage to make tough decisions.