Abstract
ObjectiveTo investigate a method of using patient-held records to collect contraception data in Malawi, that could be used to explore contraceptive discontinuation and method switching.MethodsIn 2012, all 7393 women aged 15 to 49 years living in the area covered by the Karonga demographic surveillance site were offered a family planning card, which was attached to the woman’s health passport – a patient-held medical record. Health-care providers were trained to use the cards to record details of contraception given to women. During the study, providers underwent refresher training sessions and received motivational text messages to improve data completeness. After one year, the family planning cards were collected for analysis.FindingsOf the 7393 eligible women, 6861 (92.8%) received a family planning card and 4678 (63.3%) returned it after one year. Details of 87.3% (2725/3122) of contacts between health-care providers and the women had been recorded by health-care providers on either family planning cards or health passports. Lower-level health-care providers were more diligent at recording data on the family planning cards than higher-level providers.ConclusionThe use of family planning cards was an effective way of recording details of contraception provided by family planning providers. The involvement of health-care providers was key to the success of this approach. Data collected in this way should prove helpful in producing accurate estimates of method switching and the continuity of contraceptive use by women.
Highlights
Access to contraceptive services is important, because of the direct effect on reproductive health, and because contraceptive use may lead to indirect improvements in general health and socioeconomic outcomes.[1,2,3]
All women aged 15 to 49 years living in the area covered by the Karonga demographic surveillance site between January and April 2012 were eligible to participate in the family planning study
6861 of the 7393 (92.8%) eligible women were issued with a family planning card
Summary
Access to contraceptive services is important, because of the direct effect on reproductive health, and because contraceptive use may lead to indirect improvements in general health and socioeconomic outcomes.[1,2,3] Contraceptive use is one of the key proximate determinants of reduced fertility,[4] which is, in turn, associated with economic development indicators. In Malawi, there has been a remarkable increase in contraceptive use over the past two decades: 7% of married women reported using a modern contraceptive method in 1992 compared with 42% in 2010.5 Paradoxically, fertility remains high. In 2010, women in Malawi bore on average 5.7 children and many pregnancies were unintended or occurred sooner than desired.[5] A reason for this paradox could be overreporting in cross-sectional surveys: a woman might report using contraception, even if in reality she has missed or delayed family planning appointments and has discontinued a short-term method. Contraceptive discontinuation and switching of methods are key factors because, as desired family size decreases and contraceptive use increases, the effectiveness and duration of contraception become increasingly important determinants of fertility, unintended pregnancies and induced abortions.[6]
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