Malawi: Family Planning Program

Where we started Family Planning programme was re-introduced as a vertical program in 1982 1992 CPR 7% 2000 CPR 26% 2006 CPR 38% 1997 Reproductive Health Unit was established & FP became an integrated part of RH services 2000, concept of EHP was adopted 2004, concept of SWAp was adopted and MOU signed with the major development partners Important characteristic of the situation is the high fertility rate, teenage pregnancy, and a young population. According to the 2004-05 Demographic and Health Survey, Malawian women have, on average, just over six births and 34% of 15 to 19 year olds have begun childbearing. According to the 2008 Preliminary Census 52% of the population is under 18 years old.

Demographic data Total Population 13 million Population under 18 52% Rural population 83% MMR 807/100,000 Teens 15-19 bearing children 35% Total Fertility Rate 6.0 Contraceptive Prevalence Rate 38% Neonatal Mortality Rate 33 Infant Mortality Rate per 72 Unmet need for FP 28 The population of Malawi is largely rural and 54 percent of its population is younger than 18 years. With a total fertility at 6, it has a CPR of 41% (38% modern contraception and 3% from traditional methods. The unmet need stands at 28% and has a high prevalence of unintended pregnancies (35%).

SRH Programme Goal Improved sexual & reproductive health for all men, women and young people in Malawi, especially the vulnerable and underserved Malawi’s SRH goal which largely includes family planning is have “improved sexual & reproductive health for all men, women and young people in Malawi, especially the vulnerable and underserved.” Over the past 15 years contraceptive prevalence among currently married women in Malawi has steadily grown from 13% in 1992 to 41% in 2006. The number of users has increased 4-fold—from 210,000 to 880,000. 4

O B S T A C L E S Inadequate resources for SWAp POW; Donor Dependence; Human resources - adequate number of well trained and deployed Limited access and quality of services Clients seeking, adopting and consistent use. Male involvement; Youth services Inadequate resources for SWAp POW translates into inadequate drug budget at district level; prioritizing procurement of drugs for curative services; inadequate FP activities in district implementation plans. Minimal Involvement of the private sector Inconsistent and inadequate supplies 5 5

Reproductive Health Policy 2009 Government of the Republic of Malawi Roadmap for the Acceleration of the reduction of maternal and Neonatal Mortality and Morbidity Government of the Republic of Malawi What has worked well: - Political commitment; - Conducive Policies - RH activities, including FP, incorporated and costed in the 2004-2010 POW - All family planning methods are part of the EHP and provided free of charge in public facilities - Contraceptive Logistics Management Information System has been expanded to the LMIS in support of all commodities required for the delivery of the EHP National Reproductive Health Strategy 2006 – 2010 Government of the Republic of Malawi Maputo Plan of Action 2007 - 2010 Government of the Republic of Malawi Implementation Plan for Sexual and Reproductive Health 2007 – 2010 Government of the Republic of Malawi Guidelines for Community Initiatives for Reproductive Health May 2007 Government of the Republic of Malawi The policy environment is very conducive and supportive to development and implementation of programmes that seek to improve the quality of sexual and reproductive life of Malawians including family planning. A number of policy documents and guidelines (both local and international) exist to support the development and implementation of programmes 6 6

Promising Strategies Liberalization of policies through reviews and updates Integration of FP into pre- service training Introduction of long term methods at community level. CBD of Orals and condoms using volunteers Introduction of Emergency Contraception Community provision of DMPA CBD program to include DMPA long-term strategy for reducing maternal disease burden and mortality FP being repositioned as part of development agenda to achieve targets for both MDGs and MGDS Increasing partnerships with private sector (Service Level Agreements with CHAM & BLM Malawi recognises family planning as a long term strategy for reducing maternal disease burden and mortality. Family planning will promote the small family size concept to improve the economic as well as health and social status of its population. As such family planning is being repositioned as a key strategy in achieving the millennium development goals as well as the Malawi Growth and Development Strategy (MGDS). Currently the contraceptive prevalence is at 38% for modern contraception. It is worthy to note that from the late 1980s to mid 1990s, Malawi had significantly registered its rapid growth in contraceptive use through a number of initiatives including, human resource development, facility upgrading and innovations to increase uptake of contraceptives such as community based initiatives and male participation. For example from --- to ---- the CPR jumped from 7 to 14 percent and then moved to from 14 to ----. ( fill in the figures and years. I intend to put this graphically). The guidelines for the provision of contraceptives were liberalised and a youth friendly health service provision concept was adopted and scaled up. Family Planning training was integrated into pre-service curriculum. Emergency contraception was introduced and recently depo provera has been introduced into the community based programmes Despite all these efforts there is a great need to promote and provide family planning, as shown by the number of potential users of FPAM who are currently not using contraceptives (unmet need - 28 percent ). The statistics also reveal that the country continues to experience a high rate of unintended pregnancy (35%). 7 7

What needs to be strengthened Advocacy at the highest levels –use of RAPID Engage multiple sectors to prioritize FP Strengthen community-based distribution programs including DMPA Implement a sustained, nationwide communication campaign to stimulate demand for FP Increase private sector-based FP service delivery Improve FP services for youth Sustain commitment and support from leaders at national and district levels and donors Guarantee availability of contraceptive commodities Overall Resource Envelope for POW

Zikomo Thank you 9 9