Family Planning in a Low Resource Setting: Attitudes and Acceptability of Long Term Contraception Methods Among Women in Mulanje Mission Hospital
Ms Nur Khalidah Rozali(1), Dr Joseph Hartland(1,2), Dr Clare Shakespeare(1,3), Dr Jessica Taylor(1,2) and Mrs Ellen Gama(3)
1.Swindon Academy, University of Bristol 2.The Great Western Hospital NHS Foundation Trust 3. Mulanje Mission Hospital
Mulanje Mission Hospital (MMH) is a not for profit hospital in Mulanje in South East Malawi. In July 2016 a Great Western Hospital student project performed a service evaluation of the Family Planning (FP) Service in MMH and interviewed staff about attitudes and acceptability of long term contraception.
Family planning (FP) is a crucial global health issue and the most cost-effective way to reduce maternal and infant mortality. Contraceptive use prevents 188 million unintended pregnancies, 1.2 million new-born deaths and 230,000 maternal deaths every year. Medical care for unintended pregnancies costs $2.5 billion USD annually; doubling to $6.9 billion USD if each received the recommended prenatal and neonatal care. Providing every woman with a FP service would cost an additional $3.6 billion USD but would result in a saving of $1.40 USD for every dollar spent on FP (1).
All women attending the Family Planning Clinic in southern Malawi, over a one month period were identified (n=902). Their age, parity, HIV status and method of contraception were obtained from the register.
A focus group with clinical staff explored local acceptability and attitudes of local women towards different forms of contraception. Thematic analysis was performed and discussed in the context of the known literature for applicable to regional demographics.
75.6% of the clinic's population were aged 20-34. The majority had a parity of 1-2 with less than <1% being nulliparous. The most commonly used contraception was depo-provera injections (89.2%), with condom use at 1.52%.
Multiple themes were found to influence use and choice of contraception, including gender inequality, family/peer pressures, perceived benefits and misconceptions. Religion was seen to have little impact on the choice of contraception for this community.
It is encouraging that provision and attendance at Family Planning Clinics in rural Malawi is around 800 women per month. Almost 90% of contraception use is depo-provera and the reasons behind this are strongly associated with societal norms, level of education and awareness of services users, their spouses and the society as a whole.
This study highlights the low numbers of adolescents and nulliparous women seeking FP advice. This suggests a potential area for improvement could focus on improved FP education for younger women; those who this study suggests are most under pressure from peers and family to have children and use depo-provera over any other contraception.
FP is growing in Mulanje especially the usage of depo-provera (90% of contraception use). Despite the positive contraception uptake, misconception and challenging traditional beliefs still exist which lead to prevention of effective contraception usage. Hence, broadening both educational content and targeting wider community are vital to ensure successful and sustainable contraception usage.
1. Government of Malawi.Malawi Costed Implementation Plan For Family Planning,2012-2016. Lilongwe:Government of Malawi;2015 p. 1-16.