It is well documented that access to contraception saves lives and is necessary for socioeconomic development – yet the allocation of resources to improve family planning programmes in developing countries has declined.
Although Malawi has made considerable progress in making contraception services more accessible to women, one in three Malawian women who want to space or limit their next birth still do not have access to contraceptives.
Pregnancy, safe motherhood and maternal mortality in Malawi
Although, there is widespread agreement about the links between pregnancy and maternal mortality and morbidity for all pregnancies, some 24-30% of women suffer from obstetric complications.
Women in Malawi have six children on average. A reduction in the number of children women choose and plan to have could help to prevent women from death and long term disability. However, only 41% of women have access to modern family planning methods.
Another 28% of women of reproductive age who, if they had access to modern family planning methods, would choose not to have any more children or who would wait two years for their next pregnancy. Finally, 40% of births are the result of either mistimed or unwanted pregnancies that continue to full term.
Free, accessible and appropriate services
Although, contraception is available cost-free, the reality is that women continue to face huge problems of access.
Even where family planning services are free, this is of little value if supplies run out and there are delays in replenishing stocks.
Health workers need appropriate training to provide accurate information and appropriate services to guide and support women to make an informed choice.
For many health workers, reproductive health and family planning can be a difficult and, at times, embarrassing, subject to deal with. Health staff need on-going training and support so that they can do their job well.
Reaching out to communities
In addition to fully stocked clinics run by well trained and confident staff, outreach services are essential if isolated communities are to have access.
In a country where 86% of the population live in rural areas, often far from health facilities, the role of Community Based Distributing Agents (CBDAs) have played a critical role in making services more accessible.
In addition to directly providing oral contraceptive pills and condoms, CBDAs in Malawi have helped to raise awareness and normalise the idea of modern family planning methods.
They also serve as referral agents for more long-lasting family planning methods such as injectables and implants.
Myths and misinformation and men as partners
Community mobilisation to address myths and misinformation is also needed as part of the package to support demand for family services.
Some common misinformation in Malawi includes that injectables and implants are unsafe and can cause miscarriage or that these methods are only suitable for second pregnancy onwards.
The active involvement of men and young boys in awareness raising programmes is essential if there is to be sustainable long term use of family planning by women, men, adolescent girls and boys.
Malawian women lack household decision-making power and often have to secure their husband’s or partner’s decision to use family planning.
Increasing access to quality contraceptive choice will empower women to decide if they want to have children, when, and how many. It will also help to save women’s lives.