Abstract
To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.
Highlights
An estimated 225 million women across the world have an unmet need for family planning (FP), and regions such as sub-Saharan Africa have much lower modern contraceptive prevalence rates and high fertility rates [1,2,3]
The literature suggests that increasing the accessibility and readiness of the health system through programs that target the training and supervision of health workers, expanding method choice at service delivery points (SDPs), or demand generation activities for FP can have a positive impact on unmet need and modern contraceptive prevalence rates (mCPR) among women of reproductive age [7,8,9]
This paper reports on the association between the implementation strength of FP programs and modern contraceptive use among Malawian women
Summary
An estimated 225 million women across the world have an unmet need for family planning (FP), and regions such as sub-Saharan Africa have much lower modern contraceptive prevalence rates (mCPR) and high fertility rates [1,2,3]. It is dismaying that so many women are denied their fundamental human right to access the FP services and methods they desire [4]. Increased use of these FP methods can have a tremendous economic benefit as well; for instance, helping to achieve the demographic dividend where more of the population are working rather than dependent, sparking much-desired economic growth in these low-income countries [5, 6]. The literature suggests that increasing the accessibility and readiness of the health system through programs that target the training and supervision of health workers, expanding method choice at service delivery points (SDPs), or demand generation activities for FP can have a positive impact on unmet need and mCPR among women of reproductive age [7,8,9]. Many governments have chosen to design and implement large-scale family planning (FP) programs that include these activities in order to bolster the readiness and delivery of FP services across their health system [12,13,14]
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