Young People’s Preferences for Family Planning Service Providers in Rural Malawi: A Discrete Choice Experiment

Abstract

ObjectiveTo quantify the impact of service provider characteristics on young people’s choice of family planning (FP) service provider in rural Malawi in order to identify strategies for increasing access and uptake of FP among youth.Methods and Findings A discrete choice experiment was developed to assess the relative impact of service characteristics on preferences for FP service providers among young people (aged 15–24). Four alternative providers were included (government facility, private facility, outreach and community based distribution of FP) and described by six attributes (the distance between participants’ home and the service delivery point, frequency of service delivery, waiting time at the facility, service providers’ attitude, availability of FP commodities and price). A random parameters logit model was used to estimate preferences for service providers and the likely uptake of services following the expansion of outreach and community based distribution (CBDA) services. In the choice experiment young people were twice as likely to choose a friendly provider (government service odds ratio [OR] = 2.45, p<0.01; private service OR = 1.99, p<0.01; CBDA OR = 1.88, p<0.01) and more than two to three times more likely to choose a provider with an adequate supply of FP commodities (government service OR = 2.48, p<0.01; private service OR = 2.33, p<0.01; CBDA = 3.85, p<0.01). Uptake of community based services was greater than facility based services across a variety of simulated service scenarios indicating that such services may be an effective means of expanding access for youth in rural areas and an important tool for increasing service uptake among youth.ConclusionsEnsuring that services are acceptable to young people may require additional training for service providers in order to ensure that all providers are friendly and non-judgemental when dealing with younger clients and to ensure that supplies are consistently available.

Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi: implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

“…Self-injectors are already having to store their new units prior to injection, and being able to dispose of used units more quickly may make self-injection more viable for covert use. This is particularly relevant to adolescents who face challenges to accessing contraceptives in general [ 31 – 34 ] and value privacy and discreetness in contraceptive use [ 3 – 5 ]. It should be noted, however, factors such as the client’s geographic proximity to the health worker and cost of transportation may influence how easy it is for self-injectors to return the units, and these factors should be considered when planning self-injection programs.…”

“…Contraceptive preferences in Uganda, Malawi, and elsewhere in sub-Saharan Africa vary according to user population. Adolescents, especially those who are not married or have not begun childbearing, fear stigma from community members and health workers for seeking family planning (FP) care [ 3 – 5 ]. Embarrassment in seeking contraceptive services often results in adolescents seeking care from health workers offering faster, more discreet services and methods [ 3 , 6 ].…”

What influences where they seek care? Caregivers’ preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment

“…In Zambia, thorough examination was the most important health facility characteristic, followed by avoiding rude staff and availability of drugs [ 17 ]. In Malawi [ 42 ] and Tanzania [ 43 ], provider attitude and reliable access to adequate quantities of drugs and equipment were the two most important utility features of a health facility for reproductive health services for young people and obstetric services for women, respectively.…”

The distance-quality trade-off in women’s choice of family planning provider in North Eastern Tanzania

“…Easily accessible and high-quality family planning facilities are important for an adequate provision of family planning services, particularly to sexually active women who are minors, unmarried and not working, but have high unmet need 5. All family planning commodities are free in public health facilities in Tanzania 6.…”