Utilisation of family planning services at the teaching hospital in Blantyre, Malawi

A study was conducted of patterns of family planning use during 1993 at the Queen Elizabeth Central Teaching Hospital in Blantyre Malawi. There were 6803 family planning visits which comprised 23% of all visits. 305 women underwent tubal ligation during 1993 yet only 319 were counseled on tubal ligation. 22% of women undergoing tubal ligation underwent interval sterilization. There were 1533 new clients and only about 1282 of them had been counseled at the family planning clinic. 1461 clients returned for their first visit that year. There were 3445 subsequent visits that year and 138 clients came back to the clinic after an absence of more than one year from the time they were scheduled to return. 226 clients discontinued the method they were using 23% of whom changed to another method. 53% of discontinuers were using the IUD. The major reason for discontinuation was to conceive again (48.2%). The women were 15-49 years old. 9% were less than 20 years old. Women 35 and over comprised 22% of the population. 58% of all clients had 1-4 children. Women with more than 5 children comprised 31%. The leading family planning methods were oral contraceptives (OCs) (42%) Depo-Provera (31%) and sterilization (21%). OCs and Depo-Provera were responsible for most family planning visits during 1993 (42% and 41% respectively). About 94% of OC users were younger than 35. Around 15% of OC users had more than 5 children. Family planning providers should have advised sterilization to the high parity users of temporary methods. For every 2.4 new clients there was 1 drop out from the clinic. For every 6.8 new clients there was 1 who discontinued the method she was using. 8% of clients conceived while using a family planning method. 77% of them were using OCs. The absenteeism rate was 29%. Some key findings of this study were inadequate counseling or missing opportunities to address family planning.