Fertility Intentions and Use of Family Planning in Northern Malawi

Women in Malawi bear on average six children, with many unintended pregnancies. Although 42% of married women use modern methods of contraception, 26% have an unmet need. The Karonga Prevention Study operates a demographic surveillance site (DSS) in northern Malawi.

An innovative method was devised for collecting family planning (FP) data using patient-held records (a “FP card”) to build a prospective longitudinal dataset, allowing exploration of continuity of use and method-switching, which can be linked to the DSS database. All 8,176 women aged 15-49 living in the DSS were offered a FP card. When a woman received FP, the health provider recorded on the FP card the date, method/service received and provider-type. After one year, the FP cards were collected for analysis.

Analysis is at an early stage but preliminary findings show that 6% of FP users used more than one method of FP during the study year (excluding condoms). Survival analysis revealed that just over a quarter of women who used injectables at the start of the study were still adhering to injections at the end of the study year. There appears to be no association between fertility intentions and discontinuation.

FP data usually come from surveys or routine data. This alternative method enables better understanding of how women maintain continuity of use.