| dc.description.abstract |
Cross-sectional estimates suggest there has been a marked increase in contraceptive use over the last twenty years in Malawi, but decreases in overall fertility have been minimal. Other than retrospectively reported contraceptive calendars, conventional assessments of contraceptive use are not designed to assess contraceptive switching or discontinuation, which may be important determinants of fertility. An innovative tool was devised for collecting family planning (FP) data using patient-held records (an “FP card”) to build a one-year prospective longitudinal dataset, allowing exploration of continuity of use and method-switching. When issuing contraception, health providers recorded data on the recipient’s FP card. The data were linked to a demographic surveillance site (DSS) in northern rural Malawi. Contraceptive services in this area are provided at government clinics, private facilities, and on outreach through a network of community-based distributors. Prospective longitudinal data were collected for 4,678 (63.3%) women, and 87.3% of provider-client contacts were captured on a paper record, by the health care provider. Lower cadres of health care providers were more diligent at recording data on the FP cards than higher cadres. Alternative methods of collecting contraceptive data such as this one can enable a better understanding of how women “shop around” for contraception services, and whether they maintain continuity of use. Involving district health office staff and health care providers was key to the success of this method to collect contraceptive data. Techniques such as refresher trainings and reminder SMS messages improve data completeness. |
en_US |