The Provider Role and Perspective in the Denial of Family Planning Services to Women in Malawi: A Mixed-Methods Study

Jill M. Peterson, Jaden Bendabenda, Alexander Mboma, Mario Chen, John Stanback and Geir Gunnlaugsson
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Jill M. Peterson: Department of Global Health and Population Research, FHI 360, Durham, NC 27701, USA
Jaden Bendabenda: Department of Nutrition and Food Safety, World Health Organization, 1211 Geneva, Switzerland
Alexander Mboma: Midwifery Department, Kamuzu University of Health Sciences, Lilongwe, Malawi
Mario Chen: Department of Global Health and Population Research, FHI 360, Durham, NC 27701, USA
John Stanback: Department of Global Health and Population Research, FHI 360, Durham, NC 27701, USA
Geir Gunnlaugsson: Faculty of Sociology, Anthropology and Folkloristics, University of Iceland, IS-102 Reykjavik, Iceland

IJERPH, 2022, vol. 19, issue 5, 1-15

Abstract: Family planning (FP) has been a global health priority for decades, yet barriers persist, including women being turned away from facilities without receiving services. This study assessed the provider role and perspective in client turnaway in three districts of Malawi. In 2019, data collectors surveyed 57 FP providers from 30 health facilities. All reported being comfortable providing FP to married women with children and married adolescents under 18 years old with children, whereas 12% of the providers expressed discomfort providing such services to married adolescents under 18 without children. Sixty percent of the providers required clients desiring FP and wishing to initiate oral contraceptives or injectables to be currently menstruating. Data collectors later conducted in-depth interviews (IDIs) with 8 of the 57 providers about client turnaway. During IDIs, providers’ most frequently mentioned reasons for turnaway was client pregnancy or suspicion of pregnancy. Providers expressed fears that initiating FP with a pregnant woman could cause community mistrust in the efficacy of modern contraception. Provider support for FP waned for nulliparous clients, regardless of age or marital status. To improve FP services in Malawi, providers need continuous education on all available methods of FP, a reduction in stockouts and programs to further sensitize the community to how contraception works. Understanding how Malawi has helped providers overcome social and cultural norms regarding provision of FP to adolescents might help other countries to make improvements.

Keywords: family planning; turnaway; sub-Saharan Africa; Malawi; provider; barrier (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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