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ORIGINAL ARTICLE
Open Access

Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It Into Practice?

Erin K. McGinn and Laili Irani
Global Health: Science and Practice December 2019, 7(4):540-550; https://doi.org/10.9745/GHSP-D-19-00192
Erin K. McGinn
aThe Palladium Group, Washington, DC, USA.
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  • For correspondence: erin.mcginn@thepalladiumgroup.com
Laili Irani
bPopulation Council, New York, NY, USA.
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Figures

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  • FIGURE 1.
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    FIGURE 1.

    Availability of Family Planning Methods in 41 Facilities in 9 Districts in Malawi, April–May 2015

    Abbreviations: ART, antiretroviral therapy; FP, family planning; IUD, intrauterine device.

  • FIGURE 2.
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    FIGURE 2.

    Percentage of Providers in 9 Districts in Malawi Who Reported Receiving Family Planning Training on Specific Contraceptive Methods, by Method and Facility Type, April–May 2015 (N=96)

    Abbreviations: CHAM, Christian Health Association of Malawi; IUD, intrauterine device.

Tables

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    TABLE 1.

    Types of Facilities From Which Data Were Collected Across 9 Districts in Malawi, by Facility Type, April–May 2015

    Type of FacilityNo.
    Health post/center/clinic19
    Public hospital9
    Christian Health Association of Malawi hospital/health center7
    Integrated health center6
    Total number of facilities41
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    TABLE 2.

    Description of Organization of Antiretroviral Therapy and Family Planning Services, According to the Health Service Provider Within Selected Facilities, by Facility Type, Malawi

    Health Centers/Posts No. (%)Public Hospitals No. (%)CHAM Missions No. (%)Integrated Health Centers No. (%)Total No. (%)
    Total number of providers54 (44.3%)32 (26.2%)21 (17.2%)15 (12.3%)122 (100%)
    Have ART services been reorganized to accommodate FP services?
    Yes43 (79.6%)26 (81.3%)17 (80.9%)15 (100%)101 (82.8%)
    No11 (20.4%)6 (18.8%)4 (19.0%)021 (17.2%)
    How have ART services been reorganized to accommodate provision of FP services?a
    Created more space8 (18.6%)4 (15.4%)3 (17.7%)4 (26.7%)19 (18.8%)
    Revised ART on-site protocols to accommodate FP services12 (27.9%)17 (65.4%)5 (29.4%)8 (53.3%)42 (41.6%)
    Trained ART providers in different FP methods21 (48.8%)11 (42.3%)4 (23.5%)12 (80.0%)48 (47.5%)
    Created informal referral agreements within facility26 (60.5%)14 (53.8%)6 (35.3%)5 (33.3%)51 (50.5%)
    Developed facility referral agreements across facilities14 (32.6%)10 (38.5%)5 (29.4%)2 (13.3%)31 (30.7%)
    Revised ART client registers to accommodate FP services4 (9.3%)4 (15.4%)1 (5.9%)2 (13.3%)11 (10.9%)
    Adjusted operating time for ART services7 (16.3%)2 (7.7%)2 (11.8%)4 (26.7%)15 (14.9%)
    Provided ART/FP on same day3 (6.9%)3 (11.5%)1 (5.9%)07 (6.9%)
    Do you have time/opportunity to counsel ART clients on FP methods?
    Yes51 (94.4%)29 (90.6%)20 (95.5%)14 (93.3%)144 (93.4%)
    No2 (3.7%)2 (6.3%)1 (4.8%)1 (6.7%)6 (4.9%)
    Not sure1 (1.9%)1 (3.1%)002 (1.6%)
    What FP methods do you counsel ART clients on?a,b
    Fertility awareness methods51 (100%)29 (100%)20 (100%)14 (100%)144 (100%)
    Pills44 (86.3%)21 (72.4%)18 (90.0%)12 (85.7%)95 (83.3%)
    Male condoms51 (100%)26 (89.7%)20 (100%)14 (100%)111 (97.4%)
    Female condoms45 (88.2%)25 (86.2%)19 (95.0%)13 (92.9%)102 (89.5%)
    Injectables47 (92.2%)26 (89.7%)20 (100.0%)14 (100%)107 (93.9%)
    IUD28 (54.9%)18 (62.1%)12 (60.0%)5 (35.7%)63 (55.3%)
    Implants43 (84.3%)19 (65.5%)16 (80.0%)10 (71.4%)88 (77.2%)
    Female sterilization34 (66.7%)20 (69.0%)11 (55.0%)7 (50.0%)72 (63.2%)
    Male sterilization25 (49.0%)13 (44.8%)7 (35.0%)5 (35.7%)50 (43.9%)
    Emergency contraception19 (37.3%)17 (58.6%)10 (50.0%)5 (35.7%)51 (44.7%)
    Are clients referred out for services?
    Yes48 (88.9%)15 (46.9%)16 (76.2%)12 (80.0%)91 (74.6%)
    No6 (11.1%)17 (53.1%)5 (23.8%)3 (20.0%)31 (25.4%)
    What prior knowledge do you have of facilities to which you are referring clients for FP services?a,c
    Services provided32 (66.7%)10 (66.7%)12 (75.0%)9 (75.0%)63 (69.2%)
    Weekdays on which services are provided34 (70.8%)11 (73.3%)6 (37.5%)7 (58.3%)58 (63.7%)
    Times when services are provided25 (52.1%)5 (33.3%)5 (31.3%)5 (41.7%)40 (44.0%)
    Transport costs to reach the referral site14 (29.2%)3 (20.0%)5 (31.3%)4 (33.3%)26 (28.6%)
    No prior knowledge5 (10.4%)5 (33.3%)1 (6.3%)2 (16.7%)13 (14.3%)
    • ↵a Categories are not mutually exclusive.

    • ↵b Of the 114 providers who counsel ART clients on FP.

    • ↵c Of the 91 providers who refer clients for services.

    • Abbreviations: ART, antiretroviral therapy; CHAM, Christian Health Association of Malawi; FP, family planning.

Additional Files

  • Figures
  • Tables
  • Supplemental material

    • Supplement 1 -

      Key Indicators from the 2010 and 2015/2016 Malawi Demographic and Health Surveys

    • Supplement 2 -

      Select Interview Questions Posed to Providers and Clients in 9 Districts in Malawi, April-May 2015

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Global Health: Science and Practice: 7 (4)
Global Health: Science and Practice
Vol. 7, No. 4
December 23, 2019
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Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It Into Practice?
Erin K. McGinn, Laili Irani
Global Health: Science and Practice Dec 2019, 7 (4) 540-550; DOI: 10.9745/GHSP-D-19-00192

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Provider-Initiated Family Planning Within HIV Services in Malawi: Did Policy Make It Into Practice?
Erin K. McGinn, Laili Irani
Global Health: Science and Practice Dec 2019, 7 (4) 540-550; DOI: 10.9745/GHSP-D-19-00192
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