Strategies for meeting the family planning needs of women in rural Africa: Evidence from Uganda and Malawi

Although the family planning and reproductive health program in Uganda has a much longer history and enjoys more donor support than that in Malawi, the contraceptive prevalence rate in Malawi is almost double the prevalence in Uganda. Similarly, while Malawi's fertility levels are declining, they have stagnated at high levels in Uganda. This paper investigates the reasons for the greater family planning program success in Malawi.

Datasets from three rounds of the Demographic and Health Surveys project were analyzed for each country. The key determinants investigated include education, rural-urban composition, risk of childhood mortality, source of family planning methods and family planning method mix.

The results show that the success of Malawi in narrowing the wide rural-urban gaps that existed in these indicators in the 1990s was a major explanation of its better family planning program performance. This is understandable given that 85% of the population of both Uganda and Malawi lives in rural areas. Malawi narrowed the rural-urban gaps by making modern contraceptives more accessible to rural areas through subsidized public service delivery points. However, Uganda sourced family planning methods mainly through the private sector. Hence, while unmet need for family planning continues to rise in rural Uganda, it is falling in Malawi.

The paper concludes that efforts to boost the adoption of modern family planning methods in Uganda must remove barriers to contraceptive methods among rural dwellers. The distribution of modern family planning methods through public health facilities seems better able to do this than the private sector.