Contraceptive Dynamics in Rural Northern Malawi: A Prospective Longitudinal Study

Increased use of contraceptives in Malawi has not translated into a commensurate reduction in fertility, but the reason for this discrepancy is unknown.  This study looks at contraceptive switching and discontinuation to see whether these phenomena may shed light on this conundrum and on whether the commonly used modern contraceptive prevalence rate (mCPR) is the best indicator of family planning program performance.

To get a relatively precise estimation of the proportion of women actually protected by a modern contraceptive on a specific day, the study’s authors created a new metric, dubbed contraceptive point prevalence. Using this measurement, this study found that the contraceptive point prevalence was 35%, slightly lower than comparable cross-sectional estimates of mCPR. Only 51% of users of the injectable—the most widely used modern method—received their first reinjection on time, and just 15% adhered to the method for 12 months.

Based on these results, the authors conclude that gaps in and discontinuation of use of the injectable may play a role in the discrepancy between mCPR and fertility. They recommend that interventions to help women adhere to injectable use and to promote long-acting methods should be strengthened.