Bringing Contraception Closer to Rural Women in Malawi

How Private and Public Sectors Work Together

By Andrea Mooney, Communications & Knowledge Management Advisor, FP/RH, PSI

Seventeen-year-old Sekani wakes up early in her rural Malawi village, and hopes her health center will have the oral contraceptive pills she uses. If it doesn’t, she will have missed a whole day of work on a farm and walked six hours for nothing. She’ll also risk getting pregnant the next time her boyfriend wants to have sex without a condom.

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Photo: © Population Services International

Sekani isn’t alone. More than 85% of Malawi’s population lives in rural areas, where unmet need for contraception is high. In rural areas, as of 2016, one in five married women (19%) and two in five sexually active unmarried women (40%) expressed a desire to delay, space, or limit births but reported they were not using contraception. Nearly a third of rural Malawian women and girls begin childbearing before age 20.[1]

If Sekani had information about and closer access to a wider range of voluntary family planning methods that included long-acting reversible contraceptives (LARCs), like implants or IUDs, she wouldn’t have to sacrifice her work day. Family planning methods like these can safely and effectively protect women and girls like Sekani from unintended pregnancy for years at a time.

To plan how to meet the needs of women like Sekani, PSI-Malawi and members of Malawi’s Ministry of Health Reproductive Health Unit meet regularly with the Malawi Family Planning Committee. These meetings include discussion of how to address the need for more access to family planning products and services, including LARCs, in Malawi’s rural areas.

With the goal of increasing access to a wide range of family planning methods for rural communities, PSI-Malawi and the Ministry of Health in Malawi (with the support of USAID and KfW) designed a solution: five collaborative teams made of one PSI clinical officer and five nurse midwives from both PSI and the Ministry of Health offered monthly mobile outreach visits to rural areas. At these visits, Sekani and other women in her community can access free family planning products and services, including LARCs. Providers use tents, churches and schools, bringing the services closer to Sekani and saving her the six-hour walk. On average, PSI mobile outreach teams have covered 20 remote and hard-to-reach sites per week.

A week before the providers arrive, community health workers show up in rural communities to assess the volume of unmet need for services. Through word of mouth, they let the women know when the providers will arrive in the next week in order to generate demand.

This model not only empowers women like Sekani to have and make choices that address their needs and desires, it also builds capacity for public health service providers, who receive on-the-job training to maintain their skills to deliver LARCs, thereby making the intervention more sustainable. By the end of 2015, PSI had trained six Ministry of Health clinical officers to offer permanent methods, 19 medical assistants and 87 nurses to provide LARC insertions and removals. In 2016, nearly 60,000 clients had voluntarily accessed a broad range of family planning options through these integrated outreach approaches. All of these services are provided within the context of informed choice, providing a wide range of methods, as well as ensuring follow up services are available for any woman who wishes to change her method or remove a LARC.

To embed this work even further into the public health system, PSI-Malawi has begun piloting a mentorship program with these public sector providers to continue their work and improve their abilities to deliver voluntary family planning. Their goal is for six districts to incorporate this training and service provision into their own budgets.

To learn more about how PSI works with the public sector to expand sustainable access to wide range of contraceptives, read our new programmatic brief Strengthening the Public Sector for a Healthier Family Planning Market: Working toward Universal Health Coverage, developed with the support of USAID SIFPO2.

[1] National Statistical Office (NSO) [Malawi] and ICF International. 2016. Malawi Demographic and Health Survey 2015-16: Key Indicators Report. Zomba, Malawi, and Rockville, Maryland, USA. NSO and ICF International.

Banner photo: © Population Services International / Banner Photo by: Miguel Samper