Key Findings

The majority of pregnancies among women living with HIV were unwanted or untimed.

Although a small sample size, the majority of pregnant women living with HIV that were interviewed (13 of 17) reported that the pregnancy was unwanted or mistimed. This echoes the finding that a majority of pregnant women on ART reported unwanted or mistimed pregnancies in a recent study in Malawi on the reproductive intentions and family planning practices of pregnant women on ART.

The overwhelming majority of clients are interested in integrated services (same day, same room, same time). They mentioned that cutting down on transportation and time would incentivize them to wait longer at visits to receive integrated services.

Clients support integrated services.

Providers indicated that they received training on HIV services (93%) and family planning services (79%). But most of those providers who had received training on family planning methods only received training on short-acting methods. Fewer still had received training specifically on the integration of HIV and family planning services.

Providers are trained in family planning, but to varying levels.

Providers mentioned that ART services had received some reorganization to accommodate family planning, with the most prevalent method of reorganization being the establishment of informal referral networks for family planning services. Few providers mentioned that ART service time was adjusted to accommodate family planning or changes in ART registers to reflect requirements from the guidelines to add columns to capture family planning service provision.

The organization of services doesn’t always support integration.

Baylor College of Medicine Children's Foundation–Malawi / Robbie Flick

Courtesy of CURE International Flickr

Most providers noted in in-depth interviews that they had the time and opportunity to counsel clients on family planning methods. But clients expressed a lack of PIFP in client exit interviews. Furthermore, most mystery client visits did not report PIFP. Mystery clients were people posing as clients seeking HIV and ART services in order to blindly evaluate whether or not PIFP was occurring and what family planning methods were available.

There is inconsistent data on PIFP meeting required guidelines.

McGinn EK, Irani L. Provider-initiated family planning within HIV services in Malawi: did policy make it into practice? Glob Health Sci Pract. 2019;7(4):540-550. https://doi.org/10.9745/GHSP-D-19-00192. Photo: Seyemon, courtesy of Flickr

Of the facilities with an ART clinic or offering HIV services, 85% (35 facilities) had family planning methods available, but largely only because facilities had condoms in stock. Out of these 35 facilities, six had a range of short and long-acting methods available. Only five sites had implants and only two sites had IUDs.

Stock outs mean that many facilities lacked a variety of methods.

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

Number of antiretroviral therapy sites

Family planning method or information available at antiretroviral therapy site

male condoms

Any method

female condoms

communication materials

injectables

pills

implants

emergency contraception

IUDs