As the world commemorated the World Contraception Day on September 26, BENEDICT CHINSAKASO, Amref Health Africa health systems advocacy manager, reflects on Malawi’s progress on the provision of family planning methods.
How would you assess the provision of family planning commodities in Malawi?
Although much work remains to be done, Malawi has made tremendous progress in recent years to increase modern contraceptive use. Malawi’s contraceptive prevalence rate [CPR] for married women of reproductive age using modern methods in 1992 was 7.4 percent. This rate increased to 28 percent in 2004 [Malawi Demographic and Health Survey 2004] and to 39 percent by 2009 [Population Reference Bureau 2009] and 58 percent in 2016 [MDHS, 2016]. Although this number is still low, it reflects a rapid increase in modern contraceptive use in Malawi. But the total fertility rate among women aged 15-49 remains high at 4.4 and unmet needs among married women of reproductive age is at 58 percent. This means that despite the tremendous progress that has been made in increasing CPR and reducing fertility rate and unmet need, more work needs to be done to further improve modern contraceptive use in Malawi.
Is the government allocating enough resources to family planning commodities?
Despite having a budget-line for family planning commodities in the health budget, not enough domestic resources are allocated to it. Most of the funds for this budget-line come from development partners. For instance, in the 2018/19 National Budget, about two percent of the projected budget for commodities was allocated from domestic resources. Therefore, there is need to increase allocation of domestic resources to this budget-line to ensure sustainability. There is also need to establish another budget-line for family planning services such as outreach clinics and awareness campaigns as they suffer due to lack of specific budget-line.
Is the nation doing enough to ensure the youth have access to family planning commodities?
Yes, efforts are being made to ensure the youth access family planning commodities. Notable efforts include youth related policies on sexual and reproductive health issues as well as the establishment of youth friendly health services in some health facilities. However, more needs to be done as some of the youth related policies on sexual and reproductive health, especially those guiding the Ministry Education and the Ministry of Health, seem to be at cross-purposes, which affects the youths’ access to modern contraceptives. There is need to harmonise the policies to ease the youths’ access to modern contraceptives. There is also need to increase the number of facilities that provide youth friendly health services as only a few facilities have such kind of services.
How can Malawi’s health system be organised to ensure access to family planning commodities?
With 76 percent of Malawians living within 8-kilometre radius of a health facility, there is need for the government to expand outreach programmes for provision of family planning commodities. For this to be effected, there is need to increase the number of human resources for health especially those sub-cadres such as health surveillance assistants and community based distribution agents who directly provide these services.
There is also need to ensure continuous availability of contraceptives in health facilities and to community distributors. This calls for allocation of enough domestic financial resources towards the procurement of contraceptives as well as ensuring an effective supply chain system. On the other hand, generation and use of real time and reliable data regarding contraceptives will also lead to accurate decisions that will accelerate contraceptive use.
However, for all this to happen, political will is key. Which is why the government should be commended for demonstrating leadership and stewardship in promoting contraceptive use and family planning practices and hope that this will continue especially by creating a family planning services budget and allocating domestic resources to this budget-line and the contraceptives budget.
what extent does culture affect family planning in Malawi?
In a study that was commissioned by Amref Health Africa Malawi in 2018-2019 in Mangochi, it was found out that culture generally does not influence contraceptive use. But it unveiled the existence of some beliefs, misconceptions and myths that affect contraceptive use. For example, the study found out that in some rural societies men are seen to be real men and given esteem among their peers if they have a lot of children. The situation makes many of them oppose the use of contraceptives which drives some women to access contraceptives in secret. It also found out that some societies have a misconception that contraceptives reduce the sexual performance of men and makes some impotent. Another misconception is that women who use contraceptives suffer from adverse side effects such as prolonged menstruations or loss of sexual desire, which negatively affected their sexual life.
What should be done to improve access and availability of family planning commodities?
There is need for continued political will to promote contraceptive use. We also need to upscale awareness campaigns to demystify misconceptions and myths around contraceptive use. Further, we need to increase the number of human resources for health who provide contraceptives and family planning services. Establishing and strengthening measures that drastically reduce stockouts of contraceptives at national, district and community levels such as by enhancing of social accountability structures is also key. Another need is the creation of a separate protected budget-line for family planning services and allocate substantial domestic resources towards family planning services and commodities.