Experiences of women accessing family planning services in Malawi: A Grounded Theory Study

Abstract Background The importance of modern contraceptive methods in averting unwanted pregnancies has been acknowledged in Malawi. Currently, the country has registered highest rates of unsafe abortions, slow decline in maternal mortality, unmet needs for contraception and a low contraceptive prevalence rate. Understanding why these rates exist is important. However, women’s views and experiences regarding uptake of family planning methods in Malawi have not been explored.Methods A grounded theory methodology was used. Data were gathered through in-depth interviews with women (n=18), men (n=10), healthcare workers (n=10); and non-participant observations of family planning clinic consultations (n=10) at three health centre settings in Malawi. Interviews, field notes and memos were analysed using constant comparative technique. Methods of open, axial and selective coding enabled subsequent conceptualisations until theoretical saturation occurred.Results The core category “disenabling environment prevents women’s family planning needs from being met” provides an understanding of women’s, men’s and healthcare workers’ experiences of contraceptive use and non-use. The disenabling environment contributed to shaping women’s family planning experiences. This was supported by three main categories: navigating the processes, disempowerment of women and learning by chance. Access to contraception use was influenced by personal beliefs and motivations, procedures to follow and inadequate resources. Women were disempowered from using contraception due to societal demands and cultural influences.Conclusion Findings from this study illuminate contextual issues into how women, men and healthcare workers experience family planning use and non-use in Malawi. A multifaceted strategy is required to support a woman’s family planning needs. At community level, awareness and education of family planning methods is required to actively inform all people in society so that they support a woman’s family planning needs. At national level, laws that would empower women with decision-making ought to be developed and enforced.