FHI 360, Durham, NC, USA.
Family Health Services, Lilongwe, Malawi.
Glob Health Sci Pract. 2024 Oct 29;12(5). doi: 10.9745/GHSP-D-24-00076.
Emergency contraceptive pills (ECPs) are effective and can be used safely at any age repeatedly within the same cycle. They are often favored by youth yet are underutilized. Private facilities can increase ECP access but present barriers including cost. Identifying effective public-sector ECP distribution models can help ensure equitable access. The Malawi Ministry of Health developed a strategy to improve ECP access in 2020. We documented ECP provision through select public, youth-serving channels recommended by the strategy: general and youth-specific outreach, paid and unpaid community health workers (CHWs), and youth clubs.
We conducted this mixed methods study from November 2022-March 2023 in 2 rural districts (Mchinji and Phalombe) implementing the strategy. We conducted qualitative interviews with 10 national stakeholders, 46 providers, and 24 clients aged 15-24 years about ECP service delivery. Additionally, 25 providers collected quantitative tally data about clients seeking ECPs. We analyzed qualitative data using grounded theory and quantitative data descriptively.
Stakeholders and providers reported ECP uptake increased in geographies where the strategy was implemented, especially among youth. Providers documented 3,988 client visits for ECPs over 3 months. Of these visits, 26% were from male clients, 36% were from clients aged younger than 20 years, and 64% received ECPs for the first time. Across channels, youth club leaders and unpaid CHWs reported the most client visits per provider and served the youngest clients. However, no ECPs were dispensed during 29% of visits due to stock-outs. While many providers were supportive of youth accessing ECPs, most held unfavorable attitudes toward repeat use.
ECP access should be expanded through provision in the studied channels, especially youth clubs and CHWs. However, to meet demand, the supply chain must be strengthened. We recommend addressing providers' attitudes about repeat use to ensure informed method choice.
紧急避孕药（ECP）在同一周期内可在任何年龄段内安全、反复使用，效果显著。它们深受年轻人的青睐，但利用率却很低。私人医疗机构可以增加 ECP 的可及性，但存在费用等障碍。确定有效的公共部门 ECP 分发模式有助于确保公平获得。马拉维卫生部于 2020 年制定了一项改善 ECP 可及性的战略。我们通过该战略推荐的特定公共、青年服务渠道（包括一般和青年特定的外展、付费和无偿社区卫生工作者以及青年俱乐部）记录了 ECP 的提供情况。
我们于 2022 年 11 月至 2023 年 3 月在实施该战略的两个农村地区（姆钦吉和法洛贝）进行了这项混合方法研究。我们对 10 名国家利益相关者、46 名提供者和 24 名 15-24 岁的客户进行了关于 ECP 服务提供的定性访谈。此外，25 名提供者收集了关于寻求 ECP 的客户的定量数据。我们使用扎根理论对定性数据进行分析，并对定量数据进行描述性分析。
利益相关者和提供者报告称，该战略实施地区的 ECP 使用率有所上升，尤其是在年轻人中。提供者在 3 个月内记录了 3988 名客户因 ECP 就诊。在这些就诊中，26%是男性客户，36%是 20 岁以下的客户，64%是首次接受 ECP。在各个渠道中，青年俱乐部的负责人和无偿社区卫生工作者报告的每名提供者服务的客户就诊次数最多，服务的客户也最年轻。然而，由于库存不足，29%的就诊没有分发 ECP。虽然许多提供者支持年轻人获得 ECP，但大多数人对重复使用持不利态度。
应通过提供研究中提到的渠道（尤其是青年俱乐部和社区卫生工作者）来扩大 ECP 的可及性。然而，为了满足需求，供应链必须得到加强。我们建议解决提供者对重复使用的态度问题，以确保知情选择方法。
