Using patient-held records to evaluate contraceptive use in Malawi

Dasgupta, Aisha; Ngwalo, Ruth; Branson, Keith; Gondwe, Levie; Taulo, Frank; Ngwira, Bagrey; Żaba, Basia; Crampin, Amelia C.

doi:10.2471/blt.14.145623

Cited by 7 publications

(11 citation statements)

References 18 publications

(12 reference statements)

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“…Of the 7,393 eligible women, 6,861 (93%) were issued a family planning card and 4,678 (63%) submitted their card after one year; participants’ mean age was 30.4 years, and the average observation time was 383 days (range, 122–519; standard deviation, 38). Nonparticipants were slightly younger, were more likely to be never married and were more educated than women who participated 30. Overall, 43% of participants used a modern method of contraception (excluding condoms) at some point during the study period.…”

Section: Resultsmentioning

confidence: 99%

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Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study

Dasgupta¹,

Żaba²,

Crampin³

2015

International Perspectives on Sexual and Reproductive Health

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Context-Increased use of contraceptives in Malawi has not translated into a commensurate reduction in fertility, but the reason is unknown. Insight into contraceptive switching and discontinuation may shed light on this conundrum and on whether the commonly used modern contraceptive prevalence rate (mCPR) is the best indicator of family planning program performance.Methods-A one-year prospective longitudinal data set was created from patient-held family planning cards of 4,678 reproductive-age women living in a demographic surveillance site in rural northern Malawi. Contraceptive service data recorded on the women's cards by providers were linked to their socioeconomic, demographic and health data. Contraceptive point prevalence estimates calculated from these data were compared with mCPR estimates from cross-sectional surveys. Survival analyses examined contraceptive adherence.Results-The contraceptive point prevalence of 35% was slightly lower than comparable crosssectional estimates of mCPR. Only 51% of users of the injectable-the most widely used modern method-received their first reinjection on time, and just 15% adhered to the method for 12 months. Although various study variables were associated with contraceptive use, none were associated with adherence.Conclusions-Gaps in and discontinuation of use of the injectable may play a role in the discrepancy between mCPR and fertility. Interventions to help women adhere to injectable use and to promote long-acting methods should be strengthened.Malawi is a poor country in Sub-Saharan Africa that has made attempts to address its population and fertility problems,1-5 by initiating programs to encourage birthspacing6 and by organizing conferences on population and development.1,7-9 Such activities may be showing some results. Malawi's modern contraceptive prevalence rate (mCPR)-the proportion of women of reproductive age who report that they (or their partner) are currently using a modern contraceptive-was six times as high in 2010 as it was in 1992 (42% vs. 7%),10 a remarkable achievement and a higher level of use than in other countries in the region.11 During that period, the percentage of married women using the injectable rose from 1.5% to nearly 26%.10 Present author contact: dasgupta@un.org. The mCPR is the most widely used measure of success of contraception programs.12,13 It is typically captured in Demographic and Health Surveys (DHS), the Multiple Indicator Cluster Survey and other large-scale national surveys with the question "Are you currently doing something or using any method to delay or avoid getting pregnant?" If the reply is "yes," the woman is asked what method she is using; nonmodern methods (e.g., withdrawal, the calendar method) are excluded for calculation of mCPR. Europe PMC Funders GroupGiven Malawi's high mCPR, the country has been heralded by the international community as a success story.14 However, the country's total fertility rate (TFR) has decreased only marginally, from 6.7 births per woman in 1992 to 5.7 in 2010,10 and r...

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Section: Resultsmentioning

confidence: 99%

“…Informed written consent for the collection and analysis of data was obtained from the study participants upon collection of the family planning cards. More detailed methods and an evaluation of the success of the data collection are described elsewhere 30…”

Section: Methodsmentioning

confidence: 99%

Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study

Dasgupta¹,

Żaba²,

Crampin³

2015

International Perspectives on Sexual and Reproductive Health

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“…All 132 health care providers working in the study catchment area were trained to record information on the FP cards whenever they provided contraception to a woman holding a card. Multiple refresher trainings were conducted, mobile phone air time was provided and motivational text messages were sent to health care providers, to keep them engaged [15].…”

Section: Study Setting and Methodsmentioning

confidence: 99%

Postpartum uptake of contraception in rural northern Malawi: A prospective study

2016

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ObjectivesCross-sectional estimates of contraceptive use do not provide understanding of time to postpartum uptake. This paper uses a range of Malawian data sources: a prospective study to explore time to uptake of contraception and a cross-sectional survey to assess whether sexually active postpartum women whose fecundity has returned use contraception, and whether abstaining/amenorrheic women report using contraception.Study designA demographic surveillance site (DSS) in Malawi was used to identify 7393 women aged 15–49 years eligible for a 1-year prospective study of contraception using provider-recorded data on patient-held records (2012–2013). This provided a reliable record of time to uptake of postpartum contraception. The average timing of resumption of sexual activities after postpartum abstinence and return of menses was estimated from a population-based sexual behaviour survey in the DSS (2010–2011).ResultsOf 4678 women recruited to the prospective contraception study, 442 delivered an infant during the observation period. Of these, 28.4% used modern contraception within 6 months of delivery. However, at 6–9 months after delivery, only 28.0% women had started menstruation and resumed sexual activities; of these, 77.6% used contraception. Amongst abstaining/amenorrheic women, a quarter reported contraceptive use.ConclusionsThe low uptake of postpartum contraception is likely due to many women abstaining and/or experiencing amenorrhea. Self-reports of contraceptive use amongst abstaining/amenorrheic women bring into question the quality of cross-sectional surveys and demonstrate that contraceptive use by women at low risk of pregnancy could contribute to the Malawi paradox of high contraceptive use and high fertility. Given relatively low risk of pregnancy in the postpartum period in this context, a focus on long-acting/permanent methods may be more effective to avert unintended pregnancies.ImplicationsThere has been increasing interest in the utility of postpartum contraceptive programmes to assist women to space births. Our findings suggest that, although uptake of contraception is low, this is partly due to postpartum abstinence and amenorrhea. Provision of long-acting/permanent methods will be more effective for women after delivery.

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“…Contraceptive users and family planning providers alike noted how helpful providers can be in warning new users about the likely experience of side effects -as well as with switching if side effects became unbearable. Many researchers have concluded the importance of quality family planning services -in particular, family planning provider counseling on the anticipated side effects and switching as one deterrent to contraceptive discontinuation (2)(3)(4)6,7,10,11,14,(22)(23)(24)(25)(26)(27)(28); while others suggest that programs and providers have little impact on continuation (13,17). One study analyzed the correlation between discontinuation rates and family planning program effort scores, and found a negative relationship, albeit weak, and concluded that family planning programs can impact discontinuation, particularly in terms of training and supervision of providers (5).…”

Section: Resultsmentioning

confidence: 99%

“…Switching from one method to another method is the ideal course of action for women and couples who desire to continue to prevent pregnancy but are not satisfied with their current method. In a study in Malawi switching within three months of discontinuation was just 4%, while in a study in Kenya, 63% of discontinuers had switched to another method within three months of discontinuation (16) , (17). A study examining switching in 23 low and middle income countries found switching to be around 60% within three months (15).…”

mentioning

confidence: 99%

“Due to the side effects she has when using the method it will be difficult for nurses to convince her to continue with that method. That’s why I said she will leave with another method.”: Family planning providers and contraceptive users in Rwanda do not consider discontinuation an option

Schwandt

Boulware

Corey

et al. 2019

Preprint

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Background Contraceptive discontinuation is a common event. Family planning programs often focus more on recruitment of new users as opposed to maintaining use among current users. A focus on sustaining users is imperative for long-term family planning program success. Methods This qualitative study in Rwanda in 2018 included eight focus group discussions with family planning providers and 32 in-depth interviews with contraceptive users. The data were collected in the two districts with the highest and lowest rates of contraceptive use, Musanze and Nyamasheke, respectively. The aim of this study is to better understand contraceptive use dynamics in Rwanda. Results Family planning providers and current users in Rwanda do not consider method discontinuation an option. Providers give support and medicine for side effects for continuers and counseling for those opting to switch. Current users are willing to try many methods until they find the right one for them – and once they find the right method, they plan to, or use the method, for long durations. Conclusions The Rwandan family planning program is primed to meet the needs of users in their sustained use of contraceptives through empathetic and responsive counseling. Concurrently, family planning users are determined to use family planning to meet their desired family size goals. The matching goals of both providers and clients indicates that contraceptive use will likely continue to increase in the future in Rwanda; however, due to long periods of pregnancy prevention desired – increased use of long acting methods should be encouraged.

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Using patient-held records to evaluate contraceptive use in Malawi

Cited by 7 publications

References 18 publications

Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study

Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study

Postpartum uptake of contraception in rural northern Malawi: A prospective study

“Due to the side effects she has when using the method it will be difficult for nurses to convince her to continue with that method. That’s why I said she will leave with another method.”: Family planning providers and contraceptive users in Rwanda do not consider discontinuation an option

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