Effect of family planning interventions on couple years of protection in Malawi.

OBJECTIVE: The primary objective was to assess the effect of family planning interventions at two health facilities in Malawi on couple years of protection (CYP). METHODS: A prospective quasi-experimental design was used to compare CYP and uptake of long-acting reversible contraception (LARC) between two intervention facilities (Area 25 Health Center and Kasungu District Hospital) and two nonintervention facilities (Mkanda Health Center and Dowa District Hospital). The interventions included community mobilization and demand generation for family planning, and training and mentoring of providers in LARC insertion. Monthly data were collected from 1 year prior to intervention implementation until 2 years thereafter. RESULTS: From the pre-intervention year to the second post-intervention year, CYP increased by 175.1% at Area 25, whereas it decreased by 33.8% at Mkanda. At Kasungu and Dowa, CYP increased by 90.7% and 64.4%, respectively. Uptake of LARC increased by 12.2% at Area 25 r, 6.2% at Kasungu, and 2.9% at Dowa, but decreased by 3.8% at Mkanda. CONCLUSIONS: The interventions led to an increase in CYP and LARC uptake. Future family planning programs should sensitize communities about family planning and train providers to provide all contraceptives so that women can make informed decisions and use the contraceptive of their choice.

Implementation of postpartum intrauterine device (PPIUD) services across 10 districts in Malawi.

Background: Malawi has a high maternal mortality and unmet need for family planning, which could be reduced by improving access to postpartum intrauterine device (PPIUD) insertion. Our objective is to describe the implementation of PPIUD services by 4 local organizations at 14 government health services across 10 districts in Malawi. Methods: This program was a collaborative effort between the Malawi Ministry of Health's Reproductive Health Directorate and 4 supporting organizations. Training, educational, and monitoring and evaluation materials for PPIUD insertion were developed between December 2013 and April 2014. Each organization was then responsible for PPIUD community sensitization, provider training, and tracking of PPIUD insertions (via PPIUD register books) at their targeted health facilities. Community sensitization activities included Open Day campaigns, which were organized by local leaders to sensitize their communities, and Population Weekends, which were organized by religious leaders to target their congregations. Results: Community sensitization activities, provider trainings, and mentoring occurred from January 2014 to June 2015, and monitoring and evaluation continued until December 2016 at some sites. One national Radio Discussion Panel with religious leaders was broadcast, 20 Open Day campaigns and 2 Population Weekends were held, 429 providers were trained during 27 trainings, and 249 PPIUD insertions occurred. Conclusions: PPIUD can be safely offered in Malawi. However, the biggest challenge with program implementation was with encouraging providers to take the extra time and effort to insert an IUD within 48 hours of delivery. In addition, frequent rotation of trained labour ward staff to other clinical areas hindered the program's sustainability since new trainings had to be held whenever staff members were rotated. Further research should be done to determine the best strategies to motivate busy providers to insert PPIUD, and PPIUD should be integrated into both medical and nursing curriculums to reduce the number of postgraduate trainings required to sustain PPIUD services.