The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

PLoS One. 2021 Nov 15;16(11):e0232504. doi: 10.1371/journal.pone.0232504. eCollection 2021.

Abstract

To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility's catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.

MeSH terms

  • Adolescent
  • Adult
  • Contraception Behavior*
  • Contraception*
  • Family Planning Services*
  • Female
  • Humans
  • Malawi
  • Marital Status
  • Middle Aged
  • Rural Population
  • Young Adult

Grants and funding

MM received funding from Global Affairs of Canada on two grants: 1) Real Accountability: Data Analysis for Results (RADAR) and the National Evaluation Program (NEP) projects. The grant number for RADAR was 7061914 and 7059904 for NEP. The URL for the funder, Global Affairs of Canada, is: https://www.international.gc.ca/gac-amc/index.aspx?lang=eng The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.