Correlates of Contraceptive Use and Health Facility Choice among Young Women in Malawi

Abstract

We explore whether differential access to family planning services and the quality of those services explain variability in uptake of contraception among young women in Malawi. We accomplish this by linking the Malawi Schooling and Adolescent Study, a longitudinal survey of young people, with the Malawi Service Provision Assessment collected in 2013–2014. We also identify factors that determine choice of facility among those who use contraception. We find that the presence and characteristics of nearby facilities with contraception available did not appear to affect use. Rather, characteristics such as facility type and whether contraception was provided free of charge determined where women deciding to use contraception obtained their contraception. We argue that in a context where almost all respondents resided within 10 kilometers of a health facility, improving access to and quality of family planning services may not markedly increase contraceptive use among young women without broader shifts in norms regarding childbearing in the early years of marriage.

Predictors of contraceptive use among adolescent girls and young women (AGYW) aged 15 to 24 years in South Africa: results from the 2012 national population-based household survey

“…Several behavioral and environmental factors have been suggested to affect correct usage, continuity and method of contraceptives preferred by AGYW. For instance, the age at sexual debut, coerced sexual intercourse, age disparate sexual relationships was associated with influencing contraceptive use [12,13]. In spite of these factors, the South African government continues to be committed to improving usage of contraceptives.…”

The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

“…289 changes in contraceptive use and fertility. 25,36,37,38 Similarly, cultural norms about marriage likely 290 play a major role in the contraceptive decisions among these women , 25,29 After controlling for 291 these factors, we found that the adjusted odds of a woman using a modern contraceptive was 292 three times as high in areas with strong implementation compared to those with weaker 293 implementation.…”

“…22,23,24 Yet, very few of these studies include outreach services or analyze the combined 105 impact of the implementation of multiple FP programs at the national scale. 25,26,30 We conducted 106 an Implementation Strength Assessment (ISA) in 2017 to measure the strength of FP programs 107 delivered across the community and facility levels in Malawi and developed a summary measure 108 that reflects the combined implementation strength of FP programs across these levels. 27 Using 109 this summary measure, this paper reports on the association between the implementation strength 110 of FP programs and modern contraceptive use among Malawian women.…”

“…295 There have been mixed results among studies aiming to demonstrate a link between structural 296 quality (an analogue to IS) and contraceptive use. 23,24,25,29,30,39,40 Most of these studies are Page 18 of 25 297 restricted to health facility data (often from Service Provision Assessments) and do not take 298 outreach services into account like this study did. This is crucial to understand better, as task 299 shifting FP provision to CHWs is a cost-efficient strategy that health authorities are increasingly 300 employing.…”

“…This finding is consistent with other 321 major drivers of improvements in mCPR. 25,33,41 Additionally, Malawian youth may use 322 pharmacies, shops, and informal outlets rather than the formal health system to obtain their 323 contraceptive methods, especially considering popular methods among youth are short acting 324 ones like male condoms. The other group that the YFHS programs targets, 20 to 24-year-olds, 325 are more likely to be married and thus, more likely to access modern contraceptives from the 326 formal health system that our ISA measures.…”