Demand for Family Planning Satisfied With Modern Methods in Urban Malawi: CHAID Analysis to Identify Predictors and Women Underserved With Family Planning Services

Abstract

BackgroundFamily planning progress under the SDGs is measured with a novel indicator, demand for family planning satisfied with modern methods (mDFPS), which provides a better indication of modern contraceptive coverage than unmet need and contraceptive prevalence rate. Yet, few studies have examined the predictors of mDFPS and the sub-groups of women with unsatisfied mDFPS in urban Saharan Africa. The objective of this study was to examine the predictors of mDFPS in urban Malawi and to identify the sub-groups of urban women underserved with modern contraceptives.MethodsThe study analysed data from the 2015-16 Malawi Demographic and Health survey. The sample comprised of 2,917 women in urban Malawi who had a demand for family planning services. We used a Chi-square (χ2) Automatic Interaction Detector (CHAID) model to address the study objectives.ResultsThe results show that the number of children a woman had was the most significant predictor of mDFPS. Women with one or more children, who were of Chewa, Lomwe or Tumbuka ethnic origin, and who resided in the central region had the highest mDFPS (87%). On the other hand, women with no children, and who were not exposed to FP information on television had the lowest mDFPS (41%). Among women in union, ethnicity was the best predictor of mDFPS. Ngoni, Yao and other ethnic minority women in union who were aged 15-19 and 40 years and above, and who were Catholic, SDA/Baptist or Muslim had the lowest mDFPS (36%).ConclusionThis study demonstrates significant intra-urban disparities in demand for FP satisfied with modern contraceptives in Malawi. There is the need for policy makers and reproductive health practitioners to recognise these disparities and to prioritise the underserved groups identified in this study.

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“…In Malawi, CPR by any method and unmet need stands at 48% and 13% in all women, which is roughly comparable to international standards (10). A recent study by Alhassan and Madise estimated mDFPs in Malawi to be around 74% (11). Total fertility rates dropped from 5.7 in 2010 to 4.2 per woman in 2018 (12).…”

“…That said, FP indicators vary widely and are affected by several socio-demographic and health system characteristics. For example, contraception use has been known to vary due to region, religion, income status, number of children, access to information or availability of proximate FP services (15). Noting such variations is important for policymakers and major players in the reproductive health sector, as the nation pushes to improve reproductive health outcomes, family planning included.…”