Department of Global Health and Population Research, FHI 360, Durham, NC 27701, USA.
Faculty of Sociology, Anthropology and Folkloristics, University of Iceland, IS-102 Reykjavik, Iceland.
Int J Environ Res Public Health. 2022 Mar 5;19(5):3076. doi: 10.3390/ijerph19053076.
Family planning (FP) has been a global health priority for decades, yet barriers persist, including women being turned away from facilities without receiving services. This study assessed the provider role and perspective in client turnaway in three districts of Malawi. In 2019, data collectors surveyed 57 FP providers from 30 health facilities. All reported being comfortable providing FP to married women with children and married adolescents under 18 years old with children, whereas 12% of the providers expressed discomfort providing such services to married adolescents under 18 without children. Sixty percent of the providers required clients desiring FP and wishing to initiate oral contraceptives or injectables to be currently menstruating. Data collectors later conducted in-depth interviews (IDIs) with 8 of the 57 providers about client turnaway. During IDIs, providers' most frequently mentioned reasons for turnaway was client pregnancy or suspicion of pregnancy. Providers expressed fears that initiating FP with a pregnant woman could cause community mistrust in the efficacy of modern contraception. Provider support for FP waned for nulliparous clients, regardless of age or marital status. To improve FP services in Malawi, providers need continuous education on all available methods of FP, a reduction in stockouts and programs to further sensitize the community to how contraception works. Understanding how Malawi has helped providers overcome social and cultural norms regarding provision of FP to adolescents might help other countries to make improvements.
计划生育（FP）几十年来一直是全球卫生重点，但仍存在障碍，包括妇女在未获得服务的情况下被医疗机构拒之门外。本研究评估了马拉维三个地区提供者在客户拒绝服务方面的角色和观点。2019 年，数据收集员调查了来自 30 个卫生设施的 57 名 FP 提供者。所有受访者都表示，他们愿意为已婚有子女的妇女和 18 岁以下有子女的已婚青少年提供 FP，但 12%的提供者表示不愿为没有子女的 18 岁以下已婚青少年提供此类服务。60%的提供者要求希望提供 FP 并希望开始服用口服避孕药或注射剂的客户目前正在经期。数据收集员随后对 57 名提供者中的 8 名进行了深入访谈（IDIs），了解客户拒绝服务的情况。在 IDIs 中，提供者最常提到的拒绝服务的原因是客户怀孕或怀疑怀孕。提供者担心为孕妇提供 FP 可能会导致社区对现代避孕措施的效果产生不信任。无论年龄或婚姻状况如何，对于初产妇，提供者对 FP 的支持都会减弱。为了改善马拉维的 FP 服务，提供者需要接受关于所有可用 FP 方法的持续教育，减少库存短缺，并进一步提高社区对避孕工作原理的认识。了解马拉维如何帮助提供者克服提供 FP 给青少年的社会和文化规范，可能有助于其他国家进行改进。
