IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0232504.html
   My bibliography  Save this article

The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi

Author

Listed:
  • Anooj Pattnaik
  • Diwakar Mohan
  • Amy Tsui
  • Sam Chipokosa
  • Hans Katengeza
  • Jameson Ndawala
  • Melissa A Marx

Abstract

To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility’s catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.

Suggested Citation

  • Anooj Pattnaik & Diwakar Mohan & Amy Tsui & Sam Chipokosa & Hans Katengeza & Jameson Ndawala & Melissa A Marx, 2021. "The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-16, November.
    • Handle: RePEc:plo:pone00:0232504
    DOI: 10.1371/journal.pone.0232504
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232504
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0232504&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0232504?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. John B. Casterline & John Bongaarts & John Bongaarts, 2017. "Africa's Unique Fertility Transition," Population and Development Review, The Population Council, Inc., vol. 43, pages 39-58, May.
    2. Julia Behrman, 2015. "Does Schooling Affect Women’s Desired Fertility? Evidence From Malawi, Uganda, and Ethiopia," Demography, Springer;Population Association of America (PAA), vol. 52(3), pages 787-809, June.
    3. Yao, Jing & Murray, Alan T. & Agadjanian, Victor, 2013. "A geographical perspective on access to sexual and reproductive health care for women in rural Africa," Social Science & Medicine, Elsevier, vol. 96(C), pages 60-68.
    4. Pritchett, Lant H. & DEC, 1994. "Desired fertility and the impact of population policies," Policy Research Working Paper Series 1273, The World Bank.
    5. Wolfgang Lutz, 2014. "A Population Policy Rationale for the Twenty-First Century," Population and Development Review, The Population Council, Inc., vol. 40(3), pages 527-544, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Jean Digitale & Stephanie Psaki & Erica Soler-Hampejsek & Barbara S. Mensch, 2017. "Correlates of Contraceptive Use and Health Facility Choice among Young Women in Malawi," The ANNALS of the American Academy of Political and Social Science, , vol. 669(1), pages 93-124, January.
    2. Donald, Aletheia Amalia & Goldstein, Markus & Koroknay-Palicz, Tricia & Sage, Mathilde, 2024. "The Fertility Impacts of Development Programs," Policy Research Working Paper Series 10848, The World Bank.
    3. Melanie Dawn Channon & Sarah Harper, 2019. "Educational differentials in the realisation of fertility intentions: Is sub-Saharan Africa different?," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-14, July.
    4. Céline Zipfel, 2022. "The demand side of Africa's demographic transition: desired fertility, wealth, and jobs," STICERD - Economic Organisation and Public Policy Discussion Papers Series 71, Suntory and Toyota International Centres for Economics and Related Disciplines, LSE.
    5. David Roodman, 2020. "The impact of life-saving interventions on fertility," Papers 2007.11388, arXiv.org.
    6. David Lam, 2011. "How the World Survived the Population Bomb: Lessons From 50 Years of Extraordinary Demographic History," Demography, Springer;Population Association of America (PAA), vol. 48(4), pages 1231-1262, November.
    7. David Wheeler & Dan Hammer, 2010. "The Economics of Population Policy for Carbon Emissions Reduction in Developing Countries," Working Papers id:3231, eSocialSciences.
    8. John B. Casterline, 2009. "Demographic Transition and Unwanted Fertility: A Fresh Assessment (The Mahbub Ul Haq Memorial Lecture)," The Pakistan Development Review, Pakistan Institute of Development Economics, vol. 48(4), pages 387-421.
    9. Mazhar Mughal & Rashid Javed & Thierry Lorey, 2023. "Female Early Marriage and Son Preference in Pakistan," Journal of Development Studies, Taylor & Francis Journals, vol. 59(10), pages 1549-1569, October.
    10. Mina Baliamoune-Lutz, 2013. "The Effectiveness of Foreign Aid to Women's Equality Organizations in the MENA: Does Aid Promote Women's Political Participation?," WIDER Working Paper Series wp-2013-074, World Institute for Development Economic Research (UNU-WIDER).
    11. Grönqvist, Hans, 2009. "Putting teenagers on the pill: the consequences of subsidized contraception," Working Paper Series 2009:8, IFAU - Institute for Evaluation of Labour Market and Education Policy.
    12. Büttner, Nicolas & Grimm, Michael & Günther, Isabel & Harttgen, Kenneth & Klasen, Stephan, 2022. "The fertility transition in Sub-Saharan Africa: The role of structural change," Passauer Diskussionspapiere, Volkswirtschaftliche Reihe V-90-22, University of Passau, Faculty of Business and Economics.
    13. Seema Jayachandran & Ilyana Kuziemko, 2011. "Why Do Mothers Breastfeed Girls Less than Boys? Evidence and Implications for Child Health in India," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 126(3), pages 1485-1538.
    14. Grant Miller, 2005. "Contraception as Development? New Evidence from Family Planning in Colombia," CID Working Papers 9, Center for International Development at Harvard University.
    15. Finlay, Jocelyn E., 2021. "Women’s reproductive health and economic activity: A narrative review," World Development, Elsevier, vol. 139(C).
    16. Henriette Engelhardt, 2004. "Fertility Intentions and Preferences: Effects of Structural and Financial Incentives and Constraints in Austria," VID Working Papers 0402, Vienna Institute of Demography (VID) of the Austrian Academy of Sciences in Vienna.
    17. Branson, Nicola & Byker, Tanya, 2018. "Causes and consequences of teen childbearing: Evidence from a reproductive health intervention in South Africa," Journal of Health Economics, Elsevier, vol. 57(C), pages 221-235.
    18. Baliamoune-Lutz, Mina, 2013. "The Effectiveness of Foreign Aid to Women's Equality Organizations in the MENA : Does Aid Promote Women's Political Participation?," WIDER Working Paper Series 074, World Institute for Development Economic Research (UNU-WIDER).
    19. Miller, Grant & de Paula, Áureo & Valente, Christine, 2025. "Subjective expectations and demand for contraception," Journal of Econometrics, Elsevier, vol. 249(PB).
    20. Lucilla Maria Bruni & Jamele Rigolini & Sara Troiano, 2016. "Forever Young?," World Bank Publications - Reports 24996, The World Bank Group.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0232504. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.