Family planning (FP) has been a global health priority for decades, yet barriers persist, including women being turned away from facilities without receiving services. This study assessed the provider role and perspective in client turnaway in three districts of Malawi. In 2019, data collectors surveyed 57 FP providers from 30 health facilities. All reported being comfortable providing FP to married women with children and married adolescents under 18 years old with children, whereas 12% of the providers expressed discomfort providing such services to married adolescents under 18 without children. Sixty percent of the providers required clients desiring FP and wishing to initiate oral contraceptives or injectables to be currently menstruating. Data collectors later conducted in-depth interviews (IDIs) with 8 of the 57 providers about client turnaway. During IDIs, providers’ most frequently mentioned reasons for turnaway was client pregnancy or suspicion of pregnancy. Providers expressed fears that initiating FP with a pregnant woman could cause community mistrust in the efficacy of modern contraception. Provider support for FP waned for nulliparous clients, regardless of age or marital status. To improve FP services in Malawi, providers need continuous education on all available methods of FP, a reduction in stockouts and programs to further sensitize the community to how contraception works. Understanding how Malawi has helped providers overcome social and cultural norms regarding provision of FP to adolescents might help other countries to make improvements.
Background: Use of herbal medicine during pregnancy and labour is often associated with obstetric complications including uterine rupture and fetal distress, but little is known about its advantages. Particularly, in-depth information on the perceptions of rural women in Malawi about the use of herbal medicine during pregnancy and labour is underreported. Knoweldge of women’s views and perceptions on use of herbal medicine would help determine potential inclusion of the suitable herbal medicine in women and reproductive health services. Aims: To explore the perceptions of women on potential use of herbal medicine during pregnancy and labour in rural Malawi. Methods: We employed a crossesctional survey on study participants (women), purposively identified (parity≥2) from four villages (Kagona, Champsinja, Mthupi and Manja) of Traditional Authority Malili, in Lilongwe rural district, Malawi. Qualtitative data was collected through four Focus Groups of 6-8 women in each group that were conducted in each village. Data analysis was performed using content analysis inductive approach. Results: A total of 28 women of reproductive age 20 and above; 20-24 (32.14%), married (75%), average of 3 deliveries (57.14%), primary school education (75.0%), and Christians (92.86%) were recruited and interviewed. Two main themes emerged from the narratives: (1) herbal medicine is beneficial: (i) hastens labour, (ii) prevents pregnancy complications and illnesses, and (2) herbal medicine is risky: (i) leads to caesarean delivery, (ii) leads to ruptured uterus and death, (iv) leads to birth asphyxia, and still births. Conclusion: Perceptions among rural women on use of herbal medicine during pregnancy and labour are deep routed on cultural and personal experiences. Health education on health related dangers associated with use of herbal medicine among rural women in Malawi can help prevent associated pregnancy and labour complications and improve maternity care. Further research is warranted to explore accessibility and community pathway systems for herbal medicine use during pregnancy and labour among the pregnant women.
Family planning (FP) has been a development priority since the mid-s, yet barriers to access persist globally, including women being turned away from facilities without a method. This study aimed to assess the extent of, and reasons for, FP turnaway in three districts of Malawi. In , data collectors screened women exiting health facilities and surveyed those who had been denied a method. Follow-up surveys were conducted via telephone with turned away clients at six and weeks postvisit. Of the , women who were screened, were new or restarting users. Of these, % (/) reported having been turned away from the health facility without an FP method. Women cited different reasons for turnaway; the top three were unavailability of method (%), unavailability of a provider (%), or a requirement to return on the scheduled FP day (%). The multiple reasons cited for leaving the health facility without an FP method indicate that reducing turnaway will not be achieved easily. The top reasons for turnaway are related to health systems or management issues within health facilities. Facilities need additional support for staffing, training on long-acting and permanent methods, and a consistent supply of methods.
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