Experiences of Women, Men and Healthcare workers Accessing Family Planning Services in Malawi: A Grounded Theory Study

Abstract

ABSTRACT Background: The importance of family planning methods in averting unwanted pregnancies has been acknowledged in Malawi. However, Malawi has registered the highest rates of maternal mortality in sub-Saharan Africa. There is a high unmet need for family planning as well as a low contraceptive prevalence rate. Only 41 percent of women aged 15-49 have used contraception, with substantial differences in use across the different districts of the country. There are knowledge gaps regarding experiences of women, men and healthcare workers for use and non-use of family planning methods in Malawi. Aim: This study aimed to gain an understanding of the experiences of women, men and healthcare workers accessing family planning services in Malawi. Methodology and Methods: A qualitative approach informed by grounded theory methodology (Strauss and Corbin, 1998) was used in this study. The study was conducted at Lumbadzi, Area 25 and Area 18 health centres in Lilongwe district of Malawi from November 2017 to August 2018. Purposive, snowball and theoretical sampling approaches were used to recruit participants. Data were collected using semi-structured in-depth interviews with 20 women, 10 healthcare workers and 10 men. Ten non-participant observations of family planning clinic consultations were conducted. Interviews, field notes and memos were analysed using constant comparative analysis. Methods of open, axial and selective coding were utilised until saturation occurred. Findings: The core category describes women’s, men’s and healthcare workers’ experiences of family planning use and non-use in Malawi: “Disenabling environment prevents women’s family planning needs from being met”. The disenabling environment contributed to shaping women’s family planning experiences. The core category was supported by three main categories: ‘navigating the processes’, ‘disempowerment of women’ and ‘learning by chance’. These major categories represent the complexities that women go through to use or not to use contraception. Access to contraception use was influenced by personal beliefs and motivations, procedures to follow and inadequate resources. Women were disempowered from using contraception due to societal demands and cultural influences. Conclusion: This study offers insights into how women, men and healthcare workers experience family planning use and non-use in Malawi. A multifaceted strategy is required to support a woman’s family planning needs. At community level, awareness and education of family planning methods is required to actively inform all people in society so that they support a woman’s family planning needs. At national level, laws that would empower women with decision-making ought to be enforced. Furthermore, the study proposes building the capacity of healthcare workers to be able to provide all contraceptive methods available at health centre level. Moreover, there is need for the commitment of the government on budgetary allocation to ensure that family planning resources are readily available at the health centres.

Date of Award	31 Dec 2019
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Alison Cooke (Supervisor) & Tina Lavender (Supervisor)