Correlates of Contraceptive Use and Health Facility Choice among Young Women in Malawi

Abstract

We explore whether differential access to family planning services and the quality of those services explain variability in uptake of contraception among young women in Malawi. We accomplish this by linking the Malawi Schooling and Adolescent Study, a longitudinal survey of young people, with the Malawi Service Provision Assessment collected in 2013-2014. We also identify factors that determine choice of facility among those who use contraception. We find that the presence and characteristics of nearby facilities with contraception available did not appear to affect use. Rather, characteristics such as facility type and whether contraception was provided free of charge determined where women deciding to use contraception obtained their contraception. We argue that in a context where almost all respondents resided within 10 kilometers of a health facility, improving access to and quality of family planning services may not markedly increase contraceptive use among young women without broader shifts in norms regarding childbearing in the early years of marriage.

Keywords: Malawi; access to family planning; adolescents; contraception.

Figure 1

Current use of contraception (pill and injectable) among MSAS females aged 14–17 in 2007 according to whether they had ever given birth and current marital status

Figure 2

Location of female MSAS respondents and health facilities that offered family planning services, 2013 Note: The map focuses on Balaka and Machinga, the districts from which our respondents were originally sampled, and where 87% of them still lived in 2013. (The remainder not shown here were scattered around the country).