Challenges in utilization of modern family planning methods among women of child bearing age in Chanunkha area, in Mzimba, Malawi

doi:10.21203/rs.3.rs-4970102/v1

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Challenges in utilization of modern family planning methods among women of child bearing age in Chanunkha area, in Mzimba, Malawi

https://doi.org/10.21203/rs.3.rs-4970102/v1

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Background

Despite increased contraceptive use in sub-Saharan Africa (SSA), the region still has high fertility and unmet contraception needs. This study explored challenges in using modern FP methods among women of childbearing age in Chanunkha area in Mzimba, Malawi.

Methodology

This study used a cross-section descriptive study design, utilizing quantitative approach. Data was collected from 96 participants using a structured questionnaire. SPSS version 23 was used to analyse the data.

Results

Most women were involved in business (56%) and farming (24%). While 70% had heard of FP methods, 17% had not. Among the total participants, 73% had used FP methods, with injectable being the most common. Many participants (61%) indicated that they did not trust FP methods. Negative attitude of health providers, rated poorly by 68%. Geographical, cultural, and religious barriers were also indicated, identified by 66%, 65%, and 66% of participants, respectively.

Conclusion

To achieve FP2030 in Malawi which aims to increase the modern use of contraceptives methods from 48% in 2020 to 60% by 2030 and SDG 3, target 3.7, the study recommends improving health provider-client interactions, integrating FP education with economic and agricultural activities, and strengthening collaboration with community and religious leaders to overcome objections.

challenges

utilisation

modern family planning

child bearing

Family planning (FP) is widely acknowledged as an effective intervention for saving women`s and children lives and improving their health [1]. However, family planning programmes in poor resource setting are usually fragile and it is exactly in these settings where family planning programmes are most needed if countries aim to reduce inequalities in health, maternal and child mortality rates and reduce poverty and also population. Among the targets (3.7) in goal 3 of the United Nations Sustainable Developments Goals (SDGs) is to ensure universal access to sexual and reproductive health care services, including family planning, information and education and the integration of reproductive health into national strategies and programs [2].

Modern contraceptives has been recognised as an effective method for fertility reduction and are being widely promoted to slow rapid population growth, particularly in developments countries [3]. Additionally, modern contraceptive methods reduce unwanted pregnancies, prevent unsafe abortions, improve maternal health and reduce infant mortality [4]. Hence, it is important that information on the use of modern contraceptive is made readily available to accelerate national efforts of achieving health goals and SDGS targets.

In 2020, out of 1.9 billion women of reproductive age (15 to 49 years), 1.1 billion were considered to have a need for family planning and 851 million of these women were using modern method of contraceptive and 85 million used traditional methods while 172 million women used no methods. Furthermore, globally as the number of women using a modern contraceptive method increased from 663 million to 851 million between 2000 and 2020, the proportion of women of reproductive age who had their need for family planning satisfied with modern methods increased gradually from 73.6% in 2000 to 76.8% in 2020, a 3.2% increase [5], [6]. Reasons for this slow increased included choice of methods, limited access to services-particularly among youths, unmarried people, fear of experience of side effects, cultural or religious opposition, poor quality of available services, users and providers bias against some methods [7].

In sub-Sahara Africa (SSA) only half of all women who wanted to avoid pregnancies in 2022 were using a modern contraceptive method while this proportion is above 80% in much developed world [5], [7]. Regardless of the advantages of the modern contraceptive methods, the use of modern contraceptive is low in SSA. Data available have shown that the prevalence rate of modern contraceptives methods use among married women or those in relationship in Africa was low estimated at 23.9% in 2012 and 28.5% in 2017 [8]. In a recent (2020) large population –based study to estimate the prevalence and factors associated with modern contraceptives method use among women of reproductive age in 20 African countries reported that overall prevalence of modern contraceptives use was 26% and ranged from 6% in Guinea to 62% in Zimbabwe and overall Injectable 32% was the preferred method of contraceptives, followed by oral pill 27% and implants 16% [9]. Unmet needs for family planning varies from regions and previous studies in SSA have shown numerous social demographic and service related predictors of why women do not use contraceptives such as women’s age, place of residence, age at cohabitation, women and husband level of education, wealth status, source of information, parity number of children and knowledge on family planning [10],[11],[12],[13].

According to United Nations-family planning and 2030 agenda for SDGs, over 20% of the global unmet needs for family planning are concentrated in 15 countries in sub-Saharan Africa [14]. It is projected that contraceptive will increase across regions of SSA by 2030 and it will increase from 17 to 27% in west Africa, 40 to 55% in Eastern Africa and 23 to 34% in middle Africa [15]. However, still this projection would not be enough to reduce the projected levels of unmet family planning needs [15],[16]. Therefore, there is need to target intervention that respond to the subnational variations that enables programs towards the achievements of the United Nations SDGs. Despite, the use of contraceptive services within SSA countries, the region is still characterized by high level of fertility rate and considerable unmet need for contraception. According to World Bank data in 2019, [17] collectively the countries of SSA had the highest average fertility rate in the world at 4.6 and Niger topped the list at 6.8 children per woman followed by Somalia at 6.0 then Democratic Republic Congo at 5.8, Chard at 5.6 and Nigeria at 5.4 children per women. These high fertility rates are attributed by low contraceptives use, early marriage, early child bearing, high social values placed in child bearing, however, many African countries are experiencing declining fertility rate for instance Nigerian`s women fertility rate reduced from 6.35 in 1960 to 5.3 in 2019 while in Uganda reduced from 5 in 2019 to 4.5 children per woman in 2022 and Zambia fertility rate reduced from 4.6 in 2019 to 4.2 in 2022 [18]. Other factors such as social demographic characteristics, structure of health systems, fear of side effects, education level contribute to the limited access as challenge to provision of family planning [19].

According to World Bank Malawi has also experienced a decline in fertility over the past decade with a reduction of fertility rate from 7 in 1960 to 3.8 children per woman in 2022 [18]. Malawi is among the 69 focus countries that made commitments to achieve the FP2020 vision to increase modern contraceptives prevalence rate for all women in Malawi from baseline of 38% in 2012 to 60% by 2020. However, according to Malawi FP2020 Assessment: Summary report, Malawi did not manage reach 60% goal for all women, but managed increase modern contraceptive from 38% in 2012 to 49% in 2020, representing an overall increase of 28.3% [20]. While Malawi demographic and health survey 2015–2016 found that modern contraceptive use by married women increased from 7% in 1992 to 58% in 2015-16 with injectable 30% popular used followed by implants 12% and female sterilization 11% while among sexually unmarried women injectable was also common with 15% followed by male condoms 14%, implants 6% and sterilization at 5% [21]. Although the contraceptive prevalence rate among women of reproductive age increased in 2020 by 28.3%, fertility rate remained high at 3.9 (2021) children per woman. Thus clearly shows that there are still barriers that prevent the utilization of family planning methods. While the access to family planning is critical attainment of the Millennium Development Goals (MDG), especially MDG 5, and also important in the reduction of poverty and improves maternal and child health, several barriers hinder contraceptive access in Malawi.

Most people live in rural areas, where traditional values are strong and gender inequality practices such as support for early marriages of girls, polygamy and widow inheritance make women less autonomous [22]. According to the Malawi demographic health survey in 2015–2016 showed a high percentage of fertility rate 4.7 in rural area compared in urban 3.0 [21]. In 2018 Mzimba district had the highest population (940,184) in the northern region with fertility at 3.34% [23]. As of 2018, majority (84%) of Malawians were rural dwellers [23]. Hence this study aims to study predictors of family planning methods in rural areas specific to Chanunkha village one of the rural areas in Mzimba. Furthermore, through the findings this study can help to achieve the family planning 2030 initiative (FP2030) that Malawi is committed to empower women and girls to make informed decision about the sexual and reproductive health and expand access to voluntary family planning services and engage men, boys, communities and marginalised population meet their family planning needs with the aim to increase the modern use of contraceptives methods to 60% by 2030.

Malawi has so far created an enabling policy environment to increase utilisation of Family planning services with specific focus to adolescent’s women with the following achievements: establishment of National family planning related policies such as National reproductive Health services delivery guidelines [24], National Sexual and reproductive Health and Rights policy [25] and National Population Policy [26].

Study design and approach

This study used a cross-section descriptive study design, utilizing quantitative approach.

Study setting.

The study was conducted at Chanunkha area in Mzimba South District in the northern region of Malawi. The area is located at the coordinates of “-13⁰ 52’ 49.99” S, latitudes and longitudes of “31⁰ 39’ 58.00”.

Study population

The study included women within child bearing age (15–49 years) living at Chanunkha area in Mzimba District, Malawi.

Sample and sample size determination

To obtain the sample size for this study, the researcher applied the Cochran formula (Cochran, 1977), using alpha of 0.5, z-score 1.96, and margin of era 0.05, to determine the sample size of 96 participants who took part in the study.

Sampling techniques

Convenient sampling technique was employed to access women who were in the community on the day and time of data collection. The researcher walked door to door in households to collect data.

Inclusion and exclusion criteria

All women between aged between 15 to 49 years qualified for inclusion into the study so long they consented. Those who were sick, mentally ill and not able to talk or hear were excluded from the study.

Data collection and management

The data was collected through interviewer administered questionnaire. The data collection tool consisted of four section namely demographic, knowledge, attitudes and practices. The collected data was kept under key and lock, and only accessible to authors. The data was collected during the month of December in 2022 to January 2023. The questionnaire took approximately 15 minutes to interview a person. The questionnaire was pre-tested on 10 women of reproductive age in a different district from where the study was conducted.

Data analysis and presentation

The questionnaires were checked for completeness, cleaned and coded. Data were then entered into Statistical Package for Social Science (SPSS) version 23 for analysis. The quantitative variables were summarised as frequencies, percentage and presented through tables.

Ethical consideration

Ethical approval was obtained from University of Livingstonia Research and Ethics Committee (UNILIA-REC/UGS/01/2022). Clearance and permission to conduct the study was obtained from the community leaders. Written informed consent was obtained from the participants before data was collected.

Demographic data

All the 96 participants responded to the questionnaire representing 100% response rate. The majority of the participant were in the age values of 21–26, (n = 34: 35%), and the least were in the age values of 39–49 (n = 4: 4%). Most of the families were headed by females (n = 54: 56%). The majority of the participants (n = 53: 55%) attended primary education, and only (n = 4: 4%) had no formal education. See Table 1.

Table 1

Demographic characteristics
Variable	Frequency	%
Age range
15–20	17	18
21–26	34	35
27–32	24	25
33–38	17	18
39–49	4	4
Marital status
Married	68	70
Single	13	14
Divorced	5	5
widow	10	10
Household Head
Male	42	44
Female	54	56
Occupation
Employment	5	5
Business	56	58
Unemployment	12	13
Farmer	23	24
Education
Primary	53	55
Secondary	37	39
Tertiary	2	2
No formal education	4	4
Religious/Denomination
CCAP	58	60
Roman Catholic	37	39
Islamic	1	1

Knowledge and use of modern FP methods among women of child bearing age.

The majority of the participants indicated that they had heard about FP methods (n = 68: 70%), while (n = 16: 17%) did not hear about FP methods. Almost (n = 65: 81%) stated that they acquired information on FP methods from the health facility, whereas (n = 10: 13%) of the participants acquired the information from friends. The results further showed that (n = 67: 70%) knew that FP methods are important whereas (n = 29: 30%) of the participants responded that FP methods are not important. Regarding the use of FP methods, majority of the participants (n = 75: 78%) had ever used FP methods and (n = 21: 22%) of the participants had not used FP methods. Furthermore, majority of the participants (n = 40: 56%) used injection (Depo Provera) as a method of FP. See Table 2.

Table 2

Knowledge and use of modern FP methods among women of child bearing age.
Variable	Frequency	%
Have you heard about Family planning
Yes	68	70
No	16	17
Partially	12	13
Source of information
Social Media	5	6
Friends	10	13
Health Facility	65	81
Ever received Family planning methods
Yes	75	78
No	21	21
Is Family planning important
Yes	67	70
No	29	30
Have You ever used Family Planning methods
Yes	75	78
No	21	22
Contraceptive methods currently on use
Female condoms	8	12
Male condoms	13	20
Norplant	4	5
Injectable	40	56
Abstinence	3	4
Pills	2	3
Duration of using contraceptives method
6 Months	24	32
1 Year	23	31
2 Years	10	14
4 years	18	23

Attitude towards modern FP methods

Based on the results presented in the Table 3, it indicates that majority of the respondent (n = 54: 56%) were satisfied with FP methods being provided whereas the remaining respondents were not satisfied (n = 42: 44%). Furthermore, the results show that (n = 31: 32%) of the participants were happy with the behaviour of health workers responsible for providing family planning methods, whereas (n = 65: 68%) of the participants were not happy with the behaviour of health providers. The majority of the participants (n = 17: 55%) responded that health providers welcomed clients warmly, (n = 8: 26%) responded that health providers were always on time and (n = 6: 19%) responded that health providers provide the required services. Regarding trust, majority of the respondents (n = 59: 61%) did not have trust in FP methods whereas (n = 37: 39%) had trust in FP methods. See Table 3.

Table 3

*Attitude towards modern FP methods*
Variable	Frequency	%
Satisfaction with FP
Yes	54	56
No	42	44
Trust in FP methods
Yes	37	39
No	59	61
Health providers behaviours towards provision of FP methods
Good	31	32
Bad	65	68
Good behaviours of health provider towards provision of FP methods
The health provider welcomes the clients warmly	17	55
The health provider is always on time	8	26
The health provider provides the required services	6	19

Factors that affect the utilization of modern FP methods according to participants.

Most of the respondents (n = 51: 53%) agreed that health providers were enough at health facility that provide FP methods whereas (n = 45: 47%) did not agree. Furthermore, the results show that (n = 63: 66%) of the participants agreed that accessibility of FP methods was affected by topography whereas the remaining, (n = 33: 34%) of the participants did not agree. The majority of the participants (n = 63: 66%) agree that accessibility of FP methods is being affected by religious beliefs and remaining of the participants (n = 33: 34%) did not agree. In addition, the majority of the participants (n = 62: 65%) agreed that accessibility of FP methods was affected by cultural beliefs and remaining (n = 34: 35%) of the participants did not agree. See Table 4.

Table 4

**Factors that affects the utilization of modern FP methods according to participants**.
Variable	Frequency	%
Number of health workers
Yes	51	53
No	45	47
Effects of topography on accessibility of FP methods
Yes	63	66
No	33	34
Effects of Religious on accessibility of FP method
Yes	63	66
No	33	34
Effects of cultural beliefs towards accessibility of family planning
Yes	62	65
No	34	35

Demographic characteristics

The study included 96 women of childbearing age from the Chanunkha area in Mzimba. The majority of respondents were within 21–26 (n = 34: 35%) and 27–32 (n = 24: 25%) age ranges, making up to 60% of the participants. The data shows a youthful demographic characteristic with a considerable group of child bearing age. This is in line with a previous study that showed a high demand on use of FP methods with women between 25 to 29 years (79%) and low demand among women between 15 to 19 and 40–44 years [27]. Most of the participants were married (n = 68: 70%), followed by single (n = 13: 14%), widowed (n = 10: 10%), and divorced (n = 5: 5%). A high number of married women in this study implies a group focused on reproductive health decisions within stable and long-term relationships. The study found that most families were headed by women (n = 54: 56%), indicating a strong need and use of family planning methods. This is as a result of many men from Mzimba District leaving the community to seek employment in South Africa, resulting in a high population of women living independently and thus using family planning methods. A similar previous study in Tanzania found that female-headed families were more likely to access contraceptive methods due to the fear of becoming pregnant (n = 176: 72%) [28].

Regarding occupation, results showed that majority of respondents engaged in business (58%), indicating a strong entrepreneurial presence or self-employment trend within the community. A significant portion of farmers (24%) highlights the importance of agriculture as a livelihood, which is common in many rural settings. The high engagement in business and agriculture shown in this study, suggest that FP education programs are needed and that integration of FP education with economic and agriculture programs can be beneficial. Offering FP counselling during agricultural training sessions or business development workshops can increase awareness and uptake of FP methods. Additionally, mobile clinics and integrations of programs can make FP services more accessible to those who may not have the time or means to visit health facilities regularly as a result of farming and business. This is supported by a previous study in Kenya on integrating FP and irrigation in Agriculture corporative activities, emphasised that cooperatives/farmers group through its trained members can be used to train members on FP issues and awareness [29].

The study also revealed that the majority of participants had attended primary education (n = 53: 55%) compared to secondary education (n = 37: 39%) and tertiary education (n = 2: 2%). This makes accessing modern family planning methods difficult, as FP-related information is better understood by those with higher literacy levels. The finding is supported by previous study by Kassim who argued that low levels of education make it difficult for individuals to comprehend various FP information from different sources [30]. Consequently, many are unable to utilize the available FP services. The results also show that majority of the participants were CCAP with 60%, followed by Roman Catholic 39%. This is an important variable to note because community members are easily influenced by religious beliefs. For example, some of the religious beliefs do not believe in the use of modern FP methods, as it is against their doctrine. As such hindering uptake of FP methods.

Knowledge and use of modern FP methods among women of child bearing age.

The data on family planning awareness and usage reveals significant insights into community knowledge and practices. A notable (n = 68: 70%) of respondents had heard about family planning, indicating widespread awareness, with health facilities being the primary source of information for (n = 65: 81%) of the participants. The findings emphasize the key role that healthcare providers play in educating the public on family planning. The results in this study also suggest that empowering health personnel is crucial for increasing the utilization of FP methods. However, (n = 16: 17%) of respondents had not heard about family planning, highlighting the need for continued outreach, especially through channels like social media, friends, school, cooperatives/groups which currently serve as minor sources of information. In support to this, a survey among secondary school girls in Tanzania identified friends at school and teachers as major sources of information on contraception [28]. Although a significant proportion of participants in this study correctly identified health personnel as the best source of information, the previous study in Tanzania emphasized that more needs to be done to understand the barriers to accessing this information on FP methods. Some previous studies have also supported the use of radios as the major source of strengthening FP information [31], [32].Lessons learned from this data, include the critical role of healthcare facilities in disseminating family planning information and the need for continuous education with different platforms to address the 17% unaware and 30% unconvinced about its importance observed in this study.

A high percentage (n = 75: 78%) ever received family planning methods, and the same proportion reports having used these methods, indicating a strong relationship between receiving information and actual usage. The importance of family planning was acknowledged by (n = 67: 70%) of respondents, but the (n = 29: 30%) who did not see its importance suggest that there are barriers that need addressing. Despite high percentage in use of FP methods in this study, previous studies in Malawi have emphasized a continuous unmet need among women of reproductive age, teenagers 16–20 years, order women 35 years and above and unmarried women [33].

Current uptake of contraceptive methods in this study was 73%. Injectable being the most common (n = 40: 56%), consisted with previous trend, followed by male condoms (n = 13: 20%) and female condoms (n = 8: 12%). The preference for injectable could be attributed to their convenience and effectiveness. A previous study in Malawi also highlighted that women prefer injectable because it is secretive that a husband will not know that a woman is using any FP methods [31]. The low usage of pills (n = 2: 3%) and Norplant (n = 4: 5%) might be due to accessibility issues, side effects, or lack of information. Abstinence, is the least practiced (n = 3: 4%) indicating that most respondents prefer active contraceptive measures. This trend is not very different from a 2010 survey in the Mbouda Health District, Cameroon, where majority of participants 76.2% used injectable [34], and (2020) large population–based study in 20 African countries with injectable 32% popular [9]. The use of injectable remains the most cited method among women of childbearing age. The preference for injectable highlights the need for accessible and wide-ranging contraceptive options to cater to different preferences. From these previous studies, data indicate that most women prefer injectable FP methods and shows a gap in use of long-term methods such as implants. This study suggests to consider increased education on the benefits, safety and convenience of other FP methods, improved access and supportive counselling from healthcare providers.

The duration of contraceptive use varied, with the majority using them for 6 months (n = 24: 32%) to 1-year (n = 23: 31%). This suggests that while there is initial uptake, long-term usage may be influenced by factors such as side effects, the need for consistent healthcare follow-up or personal and societal influences. Remarkably, a significant portion (n = 18: 23%) has been using contraceptives for 4 years, indicating a subset of the population that is committed to long-term family planning. Furthermore, the data implies that family planning programs should not only focus on the initial provision of methods but also ensure continuous usage through regular follow-ups and addressing concerns related to side effects and misconceptions.

Attitude towards modern FP methods

The study data on satisfaction and trust in family planning methods revealed significant challenges and areas for improvement. Only (n = 54: 56%) of respondents were satisfied with FP services and a mere (n = 37: 39%) trust these methods with (n = 59: 61%) expressing distrust. This lack of trust can severely undermine the effectiveness of FP programs, as confidence in the methods is critical for their consistent and correct usage. The results in this study indicate a generally low attitude towards FP methods among the respondents, suggesting that those currently on FP are at high risk of discontinuing. This data implies for continued awareness and it is supported by a previous study in Malawi that underlined that FP programs should strive to provide correct information through community mobilisation and ensure availability and skilled provision of all methods [35].

The negative perception of health providers' behaviours is particularly concerning with (n = 65: 68%) rating their experience as bad. This suggests that the manner in which FP services are delivered significantly impacts user satisfaction and trust. Previous study in Malawi underlined the level of disrespectful care has potential to impact access and utilization, however, it was noted that insufficient human resource and facilities found in many low income settings were contributing factors for the disrespectful [36]. Among 32% who did perceive positive behaviours (n = 17: 55%) appreciated being welcomed warmly, (n = 8: 26%) valued timely services and (n = 6: 19%) felt they received the necessary services. These aspects of positive interactions highlight the importance of client-provider relationships in the successful implementation of FP programs. Even though majority of participants in this study rated their experience as bad from the health providers.

Lessons learned from study include the critical need for improving health provider-client interactions. Training programs for health providers should emphasize the importance of a warm, respectful and timely service delivery. Addressing the high rate of perceived poor behaviour (68%) among providers is essential. Regular evaluations and feedback mechanisms can help ensure that providers maintain high standards of service. These findings suggest that improving the interpersonal skills of health providers could enhance trust and satisfaction with FP methods. Trust-building measures such as community education on the efficacy and safety of FP methods are necessary to address the 61% distrust. Additionally, the data indicates that satisfaction with FP services is not only dependent on the methods themselves but also significantly influenced by the quality-of-service delivery.

Factors that hinder the utilization of modern FP methods

The data on factors influencing the accessibility of family planning methods highlights several critical barriers that need to be addressed to improve FP services. The data shows a nearly even split regarding the number of health workers with (n = 51: 53%) indicating a sufficient number and (n = 45: 47%) reporting inadequacies. This suggests that while some areas may have adequate health personnel to provide FP services others are struggling with shortages. Addressing these disparities is crucial to ensuring consistent and widespread access to FP methods. Ensuring an adequate number of health workers/providers is essential particularly in underserved areas, such as rural areas.

Topography significantly affects the accessibility of FP methods, with (n = 63: 66%) of respondents acknowledging its impact in this study. Difficult landscapes can hinder travel to health facilities, making it challenging for individuals in remote or mountainous regions to obtain FP services. This highlights the need for targeted strategies such as mobile clinics and community-based distribution to reach populations in hard-to-access areas. Religious influences are also a significant factor with (n = 63: 66%) of respondents noticing their effect on FP accessibility. In communities where religious beliefs strongly oppose certain FP methods, there may be resistance to their use. This underlines the importance of engaging religious leaders and communities in discussions the benefits of FP promoting methods that align with their values, and providing culturally sensitive education to mitigate opposition. Consistent with findings from other studies, religious beliefs negatively impacted FP literacy among women of childbearing age. Some participants indicated that using FP methods conflicts with their religious beliefs. This aligns with a study by Sundararajan et al. (2019) in Tanzania, found that while some religious leaders promote FP method while others do not [37]. This situation limits FP literacy among women and creates a dilemma about whether to use these methods. Engaging with religious and cultural leaders to promote acceptance and understanding of FP methods is crucial for overcoming resistance.

Cultural beliefs pose another barrier with (n = 62: 65%) of respondents indicating that cultural factors affect FP accessibility. Traditional beliefs and societal norms can discourage the use of FP methods particularly for women due to misconceptions or the prioritization of large families. This is line with a previous study in Malawi that reported that men are main decision makers within the household regarding the use of FP methods and services [38]. However, in this study most women are family heads as a result of their husband migrating to South Africa to search for employment. As such women are free to make their own decision, one of the key reasons majority of women in this study are on FP methods. Community outreach programs that include education about the health and economic benefits of FP and efforts to involve men and community leaders in these discussions can help shift cultural attitudes.

This study emphasizes the need for a complex approach to improving FP accessibility. The findings suggest that adjusted interventions are necessary to address the diverse barriers to FP accessibility. Policymakers and health organizations should consider the unique challenges faced by different communities whether they are geographical, religious, or cultural. By adopting a holistic approach that combines increasing health workforce capacity, improving physical access, and promoting cultural and religious acceptance, FP programs can become more effective and equitable, ultimately leading to better health outcomes for individuals and communities.

Limitations

The nature of the study design used (cross-sectional) is limited and not possible to establish causal inferences. Secondly, the study was conducted in Chanunkha village in Mzimba, as such it is not possible to generalise the findings to other settings due to differences in various demographic characteristics.

The study demonstrates negative attitude of health provider’s behaviours towards women, fair knowledge and uptake on FP methods. Geographical challenges, cultural, and religious barriers also hindered FP services and uptake. As part of the efforts to achieve FP2023 which aims to increase the modern use of contraceptives methods from 48% in 2020 to 60% by 2030 and SDG 3, target 3.7 that aims to ensure universal access to sexual and reproductive health care services, including family planning, information and education and the integration of reproductive health into national strategies and programs. The study recommends critical need for improving health provider-client interactions to ensure trust and attitude, scaling up integration of FP education with economic and agriculture programs in communities and FP education on benefits of various FP methods and strengthening Collaboration with community and religious leaders to overcome objections. Effectiveness of various training programs aimed at improving health provider attitudes and behaviours must be further investigated.

FP Family planning

SSA Sub Saharan Africa

SDG Sustainable Developments Goals

MDG Millennium Development Goals

CCAP Church of Central Africa Presbyterian

Acknowledgement

Authors are thankful to all participants who took part in the study

Funding

There was no special funding for this study

Conflict of interest

All authors declare no conflict of interest

Data availability

Data is available on request through the corresponding author

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No competing interests reported.

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Challenges in utilization of modern family planning methods among women of child bearing age in Chanunkha area, in Mzimba, Malawi

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Abstract

BACKGROUND

METHODOLOGY

Study design and approach

Study population

Sample and sample size determination

Sampling techniques

Inclusion and exclusion criteria

Data collection and management

Data analysis and presentation

Ethical consideration

RESULTS

Demographic data

Attitude towards modern FP methods

DISCUSSION

Demographic characteristics

Attitude towards modern FP methods

Factors that hinder the utilization of modern FP methods

Limitations

Conclusion and Recommendation

Abbreviation

Declarations

References

Additional Declarations

Status:

Version 1