Malawian women bear on average six children in their life-time, and many of these are unintended or occur sooner than desired. HIV infection is high; roughly 13% of adult women are positive. Although 42% of married women use modern methods of contraception, a further 26% are estimated to have an “unmet need” for contraception for either spacing their births, or stopping child-bearing altogether. Reasons for non-use among these women may include lack of availability or access to health services, husband-disapproval, health concerns, or issues with cultural acceptability. I am interested in the relationship between fertility desires and family planning use in Malawi – and the motivations and barriers for women to use family planning to effectively control their fertility – and the Leverhulme Trust has funded me for a 24 month Study Abroad Studentship to explore these issues.
I am a student jointly at the College of Medicine, University of Malawi, and a PhD student at the London School of Hygiene and Tropical Medicine. I carry out my field-work through the Karonga Prevention Study, which is a scientific research site in northern rural Malawi (include map?). A range of family planning methods is provided in the area through different mechanisms and service providers – including clinical officers and nurses at government or private health clinics, and community health workers providing outreach services to the underserved. Basic family planning data are collected at health facilities in the study area, but collating these data would not offer the opportunity for linking between facilities or providers in order to track the extent of facility or method-switching, or continuity of provision. With such a range of family planning sources and poor record-keeping, there is need to better understand if and how women “shop around” for services and how they maintain continuity of use to protect themselves from unintended pregnancies.
I have designed and rolled-out a research study – funded by the University of North Carolina at Chapel Hill (http://www.cpc.unc.edu/measure/prh/small-grants-program) – where over 6,000 women aged 15-49 living in the study area have had a family planning card attached to the inside front page of her health passport. When she receives a family planning service, the health provider marks on the card the date, method received, and facility/provider type. After one year, the cards will be collected for data entry and statistical analysis. In the second year of my Studentship, I intend to carry out qualitative in-depth interviews with a small sample of women to explore in greater depth community perceptions about desirability of childbearing, and the reasons for family planning switching or discontinuation behaviour. The rationale for conducting this type of research is to better understand family planning behaviour in these contexts, and ultimately to improve provision for underserved women.