ASSESSING BARRIERS OF CONTRACEPTIVE UPTAKE AMONG ADOLESCENT GIRLS IN A RURAL DISTRICT OF MALAWI

Abstract

Background: The unmet need for family planning for unmarried adolescents in Malawi remains high despite efforts to improve provision, leading to a high rate of adolescent pregnancies. In Neno District, there is a 52% unmet need for family planning in adolescents, with 32% of young women giving birth before 18 years of age. Methods: We conducted a mixed-methods study on family planning provision for adolescent women in Neno District. First, we collected data from (a) family planning reports from 11 health facilities, (b) mHealth Community Health Worker data from two catchment areas, and (c) facility survey data from six randomly selected facilities. Then, we conducted three focus group discussions comprised of teachers and parents and 32 in-depth interviews with 20 adolescents, four local leaders, four service providers, and four facility managers. Results: Despite the health facilities being stocked with required resources, the uptake of family planning among adolescents was very low, with only 2.9% of adolescents 10-14 years and 10% of adolescents 15-19 years accessing family planning services in the Neno district in 2019. In 2020, the uptake was 20% lower than in 2019, in part due to the COVID-19 pandemic. Uptake was higher in the dry season compared to the rainy season. We identified barriers to contraceptive uptake including lack of youth-friendly health services, poverty, lack of privacy, misuse of media, and the impact of the COVID-19 pandemic. Conclusions: Barriers to adolescent contraceptive uptake are multi-sectoral and inadequately addressed by existing programs in Malawi. Efforts are needed to provide effective and culturally acceptable interventions to increase adolescent contraceptive uptake.