Determinants of contraceptive choices in Malawi
Martin E. Palamuleni
Volume: IX Issue: 1, Pages: 49-80
Martin E. Palamuleni
“Population Training and Research Unit, North-West University,
Private Bag X2046, Mmabatho 2735, Republic of South Africa,
This paper uses data from the 2000 and 2004 Malawi Demographic and Health Surveys to examine the factors explaining the contraceptive method choice in Malawi. The overall proportion of users relying on female sterilization rose from 1.7% to 7.5% whereas the proportion of users relying on injectables increased from 1.5% to 19.2% between 1992 and 2010. The proportion of married contraceptive users relying on the pill remained unchanged at 2% and the proportion using condom increased slightly from 1.6% to 2.7% over the same period. Use of traditional methods declined from 5.7% to 3.2%. Multinomial logistic regressions were used to study the determinants of the contraceptive method-choice. The results show that the major factors influencing the use of injectable, sterilisation, pills, condoms and other methods are age, partners’ approval of family planning, family planning discussion with partner, number of living children, work status, education and visit to a health centre. As a policy measure, information, education and communication programmes on family planning should be intensified, particularly in rural areas and targeting men.
Keywords: Malawi, Contraceptive use, logistic regression, socio-economic, Demographic and Health Survey
Adanu, R.M.K., Seffah, J.D., Hill, A.G., Darko, R., Duda, R.B., Anarfi, J.F. (2009). “Contraceptive Use by Women in Accra, Ghana: Results from the 2003 Accra Women’s Health Survey”. African Journal of Reproductive Health 13(1): 123-134.
Anguko, A.A. (2014). Determinants of contraceptive use among women of reproductive age in North Eastern Kenya. Masters Thesis. Nairobi:University of Nairobi.
Audu, B., Yahya, S., Geidama, A., Abdu Ssalam, H., Takai, I., Kyari, O. (2008). “Polygamy and the use of contraceptives”. International Journal of Gynaecology and Obstetrics 101(1): 88-92. Bankole, A., Singh, S. (1998). “Couples fertility and contraceptive decision making in developing countries hearing men’s voice”. International Family Planning Perspectives 24: 15–24.
Bersamin, M., Todd, M., Remer, L. (2011) “Does distance matter? Access to family planning clinics and adolescent sexual behaviours”. Maternal Child Health Journal 15(5): 652-659. Black, A., Yang, Q., Wen, SW., Lalonde, AB., Guilbert, E., Fisher, W. (2009). “Contraceptive Use Among Canadian Women of Reproductive Age: Results of a National Survey”. Women’s Health: 627-640.
Blake, M., Babalola, S. (2000). “Impact of a Male Motivation Campaign on Family Planning Ideation and Practice in Guinea”. In Field Report No 13. Center for Communication Programs. Baltimore: Johns Hopkins University.
Bloomberg School of Public Health. Bruce, J. (1990). “Fundamental elements of the quality of care: a simple framework”. Studies in Family Planning 21(2): 61-91.
Bulatao, R. A. (1989). “Toward a framework for understanding contraceptive method choice”. In Bulatao, R. A., Palmore, J. A. & Ward, S. E. (eds). Choosing a Contraceptive: Method Choice in Asia and the United States. Boulder, Colorado: Westview Press, pp. 277–304.
Chimbwete, C, Watkins, S.C., Zulu, E.M. (2005). “The evolution of population policies in Kenya and Malawi”. Population Research and Policy Review 24: 85– 106.
Chintsanya, J. (2013). “Trends and Correlates of Contraceptive Use among Married Women in Malawi: Evidence from 2000-2010 Malawi Demographic and Health Surveys”. DHW Working Paper No. 87. ICF International.
Calverton, Maryland, USA. Cleland, J. et. al. (2006). “Family planning: the unfinished agenda. The Lancet Sexual and Reproductive Health Series”. Sexual and Reproductive Health 3. October.
Cohen, B. (2000). “Family Planning Programs, Socioeconomic Characteristics, and Contraceptive Use in Malawi”. World Development 28(5): 843-860.
Curtis, S.L., Katherine, N. (1996). Contraceptive knowledge, use and sources, demographic and health survey. comparative studies No.19. Calverton: Maryland: International. Inc.
Dang, A. (1995). “Differentials in contraceptive use and method choice in Vietnam”. International Family Planning Perspectives 21(1): 2–5.
Dehlendorf, C.L.K, Ruskin, R., Steinauer, J. (2010). “Health care providers’ knowledge about contraceptive evidence: a barrier to quality family planning care?”. Contraception 81: 292-298. Dodoo, F.N. (1998). “Men matter: Additive and interactive gendered preferences and reproductive behavior in Kenya”. Demography 35: 229– 42.
Diro, C.W and Mesganaw, F.A (2013). “Agreement and concordance between married couples regarding family planning utilization and fertility intention in Dukem, Ethiopia”. BMC Public Health 13: 903 doi:10.1186/1471-2458-13-903.
Ezeh, A.C. (1993). “The influence of spouses over each other’s contraceptive attitudes in Ghana”. Studies in Family Planning 24 (3): 163-174.
Feyisetan, B.J. (2000). “Spousal communication & contraceptive use among the Yoruba of Nigeria”. Population Research and Policy Review 19(1): 29-45.
Feyisetan, B.J and Bankole, A. (2002). Fertility Transition in Nigeria: Trends and Prospects. A country paper for the Expert Group Meeting on Completing the Fertility Transition. 11-14 March. New York.
Frost, J.J, Singh, S., Finer L.B. (2004). “Factors associated with contraceptive use and non-use in United States”. Perspective on Sexual and Reproductive Health 39.
Gregson, S., Zhuwau, T., Anderson, R.M., Chandiwana, S.K. (1999). “Apostles and Zionists: The influence of religion on demographic change in rural Zimbabwe”. Population Studies 53: 179–193.
Gyimah, S.O., Takyi, B., Tenkorang, E.Y. (2008). “Denominational affiliation and fertility behaviour in an African context: An examination of couple data from Ghana”. Journal of Biosocial Science 40: 445–458.
Hogan, D.P., Berhanu, B., Hailemariam, A. (1999). “Household organization women’s Autonomy, & contraceptive Behaviour in southern Ethiopia”. Studies in Family Planning 30 (34): 302-314.
Kabagenyi, A., Ndugga, P., Wandera, S.O and Kwagala, B. (2014) “Modern contraceptive use among sexually active men in Uganda: does discussion with a health worker matter?”. BMC Public Health 14: 286. doi:10.1186/1471-2458-14-286.
Kalanda, B. (2010). “Repositioning family planning through community based distribution agents in Malawi”. Malawi Medical Journal 22(3): 71-75.
Kalipeni, E., Zulu, E.M. (1993). “Gender differences in knowledge and attitudes toward modern and traditional methods of child spacing in Malawi”. Population Research and Policy Review 12 (2): 103-121.
Kishindo, P. (1995). “Family Planning and the Malawian Male”. Nordic Journal of African Studies 4(1): 26-34.
Kulczycki, A. (2008) “Husband-Wife Agreement, Power Relations and Contraceptive Use in Turkey” International Family Planning Perspectives 34(3): 127–137.
Malawi Government (1994a). National Population Policy. Office of the President and Cabinet: Department of Economic Planning and Development, Lilongwe. Malawi Government (1994b). Malawi Demographic and Health Survey 1992. Zomba.: National Statistical Office and Macro International Inc. Malawi Government (2002).
Malawi Demographic and Health Survey 2000. Zomba: National Statistical Office and Macro International Inc. Malawi Government (2006). Malawi Demographic and Health Survey 2004. Zomba.: National Statistical Office an and Macro International Inc. Malawi Government (2011). Malawi Demographic and Health Survey 2010. Zomba.: National Statistical Office an and Macro International Inc.
Mamdani, M., Garner, P., Harpham, T., Campbell, O. (1983). “Fertility and contraceptive use in poor urban areas of developing countries”. Health policy and Planning 8(1): 1-18.
Mannan, H.R. (2002) “Factors in contraceptive method choice in Bangladesh: goals, competence, evaluation and access”. Contraception 65(5): 357-364.
Magadi, M.A., Curtis, S.L. (2003). “Trends and Determinants of Contraceptive Method Choice in Kenya”. Studies in Family Planning 34(3): 149-159.
Mostafa Kamal, S.M. and Islam, A. (2010) “Contraceptive Use: Socioeconomic Correlates and Method Choices in Rural Bangladesh”. Asia-Pacific journal of Public Health 22: 436 (DOI: 10.1177/1010539510370780).
Mostafa Kamal, S.M. (2012) “Inter-Spousal Communication and Its Effect on Contraceptive Use Pattern among Rural Women in Bangladesh”. Paper presented at the Population Association of America Annual meeting, 3-5 May 2012, San Francisco.
Nalwadda, G., Mirembe, F., Byamugisha, J., Faxelid, E. (2010). “Persistent high fertility in Uganda: young people recount obstacles and enabling factors to use of contraceptives”. BMC Public Health 10(1): 530.
Nwankwo, B.O, Ogueri, E. (2006). “Influence of Husband’s Decision on the Use of Modern Contraceptives Among Rural and Urban Married Women in Imo State, Nigeria”. International Journal of Tropical Medicine 1(40): 140-144.
Palamuleni, M.E. (2013). “Socio-Economic factors affecting contraceptive use in Malawi”. African Journal of Reproductive Health 17(3): 91- 104.
Robey, B., Rutstein, S.O., Morris, L. (1992). “The Reproductive Revolution: New Survey Findings”. Population Reports. Series M. Number 11.
Rutherford, R.D, Thapa, S., Desilva, V. (1989). “Strength of fertility Motivation: Its Effects on contraceptive Use in Rural Sri Lanka”. Asia pacific population Journal 4(4): 21-44.
Saleem, S., Martin, B. (2005). “Women’s autonomy, education and contraception use in Pakistan: a national study”. Reproductive Health 2: 8.
Shah, N.M., Shah. M.A., Radovanovic. Z. (1998). “Patterns of desired fertility and contraceptive use in Kuwait”. International Family Planning Perspectives 24(3): 133–138.
Sharan, M.V.T. (2002). “Spousal communication and family planning adoption: effects of a radio drama serial in Nepal”. International Family Planning Perspective 28(1): 16–25.
Solo, J, Jacobstein, R., Malema, D. (2005). Repositioning family planning—Malawi case study: Choice, not chance. New York: The ACQUIRE Project/EngenderHealth.
Seiber, E.E, Bertrand, J.T., Sullivan, T.M, (2007). “Changes in Contraceptive Method Mix in Developing Countries” International Family Planning Perspectives 33(3): 117–123.
Stanback, J. and Twum-Baah, K.A. (2001). “Why Do Family Planning Providers Restrict Access to Services? An Examination in Ghana”. International Family Planning Perspectives 27(1):37-41.
Takruri, A, Taulo, F, Larsen-Reindorf, R., Makumbi, F., Okunlola, M., Becker S, Tsui, A. (2013). Determinants of Couples’ Fertility Desires and Concordance in Reported Contraceptive Use: Insights from Five Peri-Urban Communities in SubSaharan Africa. Paper presented at PAA 2013.
Ullah, S., Chakraborty, N. (1993). “Factors Affecting the Use of Contraception in Bangladesh: A Multivariate Analysis”. Asia-Pacific Population Journal. 8(3):19-30. United Nations (1996). Programme of Action Adopted at the International Conference on Population and Development Cairo. New York: UNFPA: 53.
Yeatman, S.E., Trinitapoli, J. (2008). “The relationship between religion and family planning in rural Malawi”. Demographic Research 19(55): 1851-1882.