Views on Family Planning and Long-Acting and Permanent Methods: Insights from Malawi

The average Malawian woman can expect to have 5.7 lifetime births, resulting in 45% of the population being younger than age 15. As these young people age, they will contribute to a large pool of couples in need of reproductive health services. Knowledge about modern contraceptive methods is high in Malawi, with nearly all women and men aware of at least one modern method. However, unmet need for family planning remains significant, with 14% of Malawian women having an unmet need for spacing and 12% having an unmet need for limiting. Long-acting and permanent methods of contraception (LA/PMs), particularly female sterilization, account for about 27% of modern contraceptive use, which is higher than in most sub-Saharan African countries. The Malawian government has strengthened various aspects of service delivery, including investing in human resources and training, deploying lower cadres of health professionals and volunteers to provide services at the community level, and expanding outreach and mobile services through public-private partnerships. Despite these investments, promoting increased use of LA/PMs can help to increase contraceptive use in Malawi and reduce unmet need for contraception. Research conducted by The RESPOND Project in 2011 and 2012 in Dowa and Kasungu districts of Malawi aimed to gain insights into the factors that may constrain the use of LA/PMs. The study involved 501 participants, including married women, men, and service providers, who were interviewed using key informant interviews, focus group discussions, and in-depth interviews. The study found that most participants favored a family of between two and five children, citing negative consequences of large families on children, parents, and communities. Participants also listed several factors that might spur a couple to have a large family, including lack of understanding about how to obtain or use family planning methods, a religious obligation to procreate, concerns about child mortality, and relationship insecurities. However, increasing understanding among the study participants was that these arguments were no longer tenable, in view of current economic realities and the availability of effective family planning methods. At the same time, couples who decide to have two or fewer children were objects of ridicule and often labeled as lazy, stingy, unwise, sick, irresponsible, and selfish. The study found that participants were highly aware of and had a positive attitude toward modern family planning methods. Women had greater knowledge about modern methods than did men, and knowledge was better in the nonpoor communities than in the poor sites. Most study participants had a positive attitude toward modern methods of contraceptives, citing benefits such as a happy family, enough care for everybody, and more time to devote to personal lives and child care. However, fear of the side effects perceived to be associated with modern methods was a factor that led some couples to opt for traditional methods, such as postpartum abstinence, medicinal herbs, and the rhythm method. The study also found that basic knowledge about the IUD was limited, with most participants saying that they had never seen or even heard of the method. Some were grossly misinformed about it, believing that the IUD was a method that a woman puts on during sex and removes thereafter.