Published in World Development in 2000, this study presents an analysis of the relative importance of various household- and community-level variables on contraceptive use in Malawi in 1992. By dividing women into subgroups along key demographic characteristics such as their education level and age, the study sought to identify the likelihood of various family planning programmes and services to influence the contraceptive use among specific groups of women.
It was hypothesised that contraceptive use is positively associated with, among other things, communication effort in fertility control and HIV/AIDS prevention. Several large-scale communication campaigns aimed at reducing fertility and raising AIDS awareness were organised in Malawi in the late 1980s and early 1990s. The study assessed the relative importance of communication programmes and other dimensions of family planning effort. To this end, the following communication-related variables were considered: women's exposure to family planning media messages; women's exposure to social marketing of condoms; and the availability of AIDS awareness campaigns.
The data were obtained from two sources. First, the author used the results of the Malawi Demographic and Health Survey conducted in 1992, which asked questions concerning, among other things, contraceptive use, knowledge of contraception, exposure to family planning social marketing campaigns and media messages, awareness of HIV/AIDS, and household demographic information. This nationwide survey collected information on 4,849 women. Second, the data from a separate Demographic and Health Survey targeting community leaders were used to identify variables concerning the quality and quantity of family planning services in local communities. Family planning services in local areas were measured through: (1) mass media exposure, (2) availability of contraceptive choice, (3) distance to nearest family planning service, and (4) the types of family planning service provision (hospital, clinic, mobile health unit, public-sector institution disseminating family planning information to residents).
The author presented the results of a multivariate analysis in which contraceptive use was modeled as a function of socio-economic characteristics of women and various dimensions of family planning programmes and services (including communication campaigns).
Results indicated that all four components of family planning programmes/services were likely to contribute to higher contraceptive use, although their relative importance varied significantly across different segments of Malawi women. The author found that contraceptive use had strong positive relations with women's exposure to communication campaigns and with the extent of contraceptive choice available in local areas. The distance to nearest family planning service was a weaker but still positive predictor of women's contraceptive use. The impact of the type of family planning service provision was present but least significant.
Exposure to communication campaigns had the greatest impact among women who were 25-30 years of age, living in urban areas, and more educated. In contrast, the availability of contraceptive choice had stronger influence on older women (age > 35), women living in rural residents, and less educated women.
Acknowledging the cross-sectional nature of the data, the author cautions against inaccurate extrapolation of the results. The author argues that more proper experimental design (for data collection and analysis) is called for to understand not simply the association but the causal relationship among the factors.
Cohen, B. (2000). Family planning programs, socioeconomic characteristics, and contraceptive use in Malawi. World Development, 28, 843-860.