Abstract
BackgroundMalawi has made progress in increasing its overall modern contraceptive prevalence rate since 2000, resulting in a dramatic reduction in its total fertility rate. However, youth, 15–24 years, have not had the same successes. Teenage pregnancies are on the rise and little progress has been made in reducing unmet need for family planning among youth. With two-thirds of the population under the age of 25 and with Malawi’s rapid population growth, reducing unmet need for family planning among youth remains a priority for the government’s reproductive health agenda. To further explore this situation, we conducted a qualitative study to explore the perspectives of youth and adults about the drivers and barriers to youth accessing family planning in Malawi and their ideas to improve services.MethodsWe conducted 34 focus group discussions with youth aged 15–24 and parents or legal guardians of female youth in 3 districts in Malawi. Focus groups were translated and transcribed. Data was input into Dedoose and analyzed using a thematic framework to identify broader patterns and themes.ResultsYouth participants felt motivated to use family planning to protect themselves from sexually transmitted diseases and to prevent unwanted pregnancies. Females focused on the consequences of unplanned pregnancies and believed family planning services were targeted primarily at them, while males thought family planning services targeted males and females equally. Barriers to youth accessing family planning included contraception misconceptions, the costs of family planning services, and negative attitudes. Parents had mixed views on family planning. While many parents acknowledged they could play a role in supporting youth, most said they are reluctant to support youth using family planning. Participants said improving counseling services, integrating family planning services and education within school curricula, and utilizing youth clubs could improve family planning services for youth.ConclusionsPolicy makers and program implementers should consider the diverse preferences among youth and parents and continue seeking their input when designing policies and programs. Youth clubs and school-based services were among the most common suggestions. However, the effectiveness of youth clubs and school-based initiatives to increase contraceptive use among youth in Malawi is not clear.
Highlights
Malawi has made progress in increasing its overall modern contraceptive prevalence rate since 2000, resulting in a dramatic reduction in its total fertility rate
A Youth friendly health services (YFHS) policy exists in Malawi, the availability and acceptability of the services provided are largely unknown. This qualitative study was conducted as part of a multifaceted, phased mixed-methods evaluation on youth-friendly family planning (FP) services to explore barriers and facilitators to access and utilization of FP services in Malawi. Research design This qualitative study used semi-structured focus group discussions (FGD) to elicit perspectives and norms about youth-friendly FP services in Malawi to allow consistency in the topics discussed and make room for additional thoughts and topics to emerge during the discussion
One moderator and one note-taker, who captured non-verbal communication and participant demographics, conducted each FGD in a private location organized by the Health Surveillance Assistants (HSA) or Non-Governmental Organization (NGO) assisting with recruitment
Summary
Malawi has made progress in increasing its overall modern contraceptive prevalence rate since 2000, resulting in a dramatic reduction in its total fertility rate. With two-thirds of the population under the age of 25 and with Malawi’s rapid population growth, reducing unmet need for family planning among youth remains a priority for the government’s reproductive health agenda. To further explore this situation, we conducted a qualitative study to explore the perspectives of youth and adults about the drivers and barriers to youth accessing family planning in Malawi and their ideas to improve services. As of 2015, Malawi reduced its child mortality by two-thirds compared to its 1990 level, mostly due to better management of childhood diseases, improved vaccination coverage, and more effective prevention and treatment of HIV and malaria [3]. In addition to reducing unwanted pregnancies increasing the modern contraceptive prevalence rate (mCPR) among youth (youth refers to those 15–24 years old as defined by the United Nations) can improve child spacing, decrease adverse birth outcomes, reduce unsafe abortions, and improve schooling for girls [6,7,8,9]
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