Malawi - Counting What Counts: Tracking Access to Emergency Contraception

Publication date: 2014

December 2014 EC is available in Malawi and is included in Malawi’s national policies and guidelines; however, it is currently available only by prescription. Almost two-thirds of Malawian women have still never heard of EC, and EC use remains very low. ABOUT MALAWI Malawi is a landlocked rural country with a population of 16,777,547, and only 15.7% live in urban areas.1 Just 5.6% of women have completed the secondary level of education.2 CONTRACEPTIVE KNOWLEDGE AND USE POLICIES Essential Drug List: The 2009 Standard Treatment Guidelines, which incorporates the Malawi Essential Medicines List, includes levonorgestrel (LNG) at the correct dose for EC.3 National norms and guidelines: EC is included in the 2011 Guidelines for Family Planning Communication, with recommendations for including EC information in key family planning messaging campaigns.4 The 2010 Preservice Education Family Planning Reference Guide includes a chapter on EC addressing use, effectiveness and misconceptions, along with case studies for providers.5 The 2006-2010 National Reproductive Health Strategy’s analysis of the country’s family planning program finds that one of its strengths is the availability of a wide variety of contraceptive methods, including EC.6 Prescription status and who is authorized to dispense: EC is available by prescription only. It is available in public sector clinics, pharmacies and NGO-led clinics. Post-rape care: The 2012 Guidelines for Provision of Comprehensive Services for Survivors of Physical and Sexual Violence in Malawi recommend that health care providers offer EC if the victim presents within 120 hours post-assault.7 In addition, a project implemented in 2011-12 tested the feasibility for police officers to provide EC to survivors of sexual assault. The study found that police officers who participated in the project were able to successfully provide EC to eligible survivors,8 suggesting the potential for continued collaboration between law enforcement and health care services. In early 2014, the Malawi Human Rights Commission submitted a proposal to a bilateral donor for continued funding of this project.9 PRODUCT AVAILABILITY Registered products: One levonorgestrel EC pill (ECP) product is registered and distributed: Pregnon (FamyCare).10 M ala wi MALAWI COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION KNOWLEDGE AND EVER USE OF MODERN CONTRACEPTION AND EC 0 20 40 60 80 100 ECAny Modern Method Knowledge Ever Use % o f A ll W om en Type of Contraception 97.9 61.8 35.1 0.7 • Total fertility rate: 5.7 children per woman (6.1 rural, 4.0 urban) • Unmet need for contraception (among all women): 18.5% • Current contraceptive modern method use (among all women): 32.6% Source: Demographic and Health Surveys, Malawi 2010 M ala w i 2 Locally manufactured products: None available. Poor quality or counterfeit EC products: While not specific to ECPs, counterfeit drugs have been found in Malawi. In 2011, in an attempt to address the problem of counterfeit goods, the government enacted anti-counterfeit legislation, which included medicines.11 Despite this legislation, Malawi still struggles with counterfeit drugs and was recently one of five countries involved in a series of raids conducted by Interpol which seized counterfeit and illicit medicines, including birth control products.12,13 WHERE WOMEN CAN ACCESS EC EC in the commercial sector: Only 3.5% of contra- ceptive users obtain their methods from private hospitals or clinics.2 The proportion of women using EC who obtain it in the private sector is not known. EC in the public sector: The public sector provides contraceptives for almost three-quarters (73.8%) of modern contraceptive users.2 However, the proportion of women using EC who obtain it in the public sector is not known. EC in the NGO, social marketing and social franchising sectors: Banja La Mtsogolo, a family planning NGO founded by Marie Stopes Inter- national,14 provides modern contraceptive methods, including ECPs,15 for 9.3% of family planning users.2 The Christian Health Association of Malawi provides contraception for 8.9% of family planning users.2 However, the proportion of women using EC who obtain it in the NGO and social marketing sectors is not known. Community-based distribution of EC: There is no community-based distribution of EC.16 MEDIA COVERAGE OF EC According to the 2010 DHS, 58% of women heard a family planning message on the radio in the past few months, making it the most frequent media source of family planning messages, while 14% of women reported seeing a family planning message in a newspaper or magazine in the past few months.2 It is not known whether this coverage was ever specific to EC. DONOR SUPPORT Donors have purchased EC for Malawi’s family planning programs. According to RHInterchange, between 2009 and 2014, seven shipments totaling 267,745 units were made to Malawi. UNFPA and USAID funded these shipments.17 REFERENCES 1 CIA The World Factbook. Africa: Malawi. Retrieved 8 October 2013, from https://www.cia.gov/library/publications/the-world-factbook/ geos/mi.html. 2 Demographic and Health Surveys, Malawi 2010. ICF Macro and the National Statistical Office, Malawi. September 2011. (http://www.measuredhs.com/pubs/pdf/FR247/FR247.pdf). 3 Government of Malawi, Ministry of Health. Malawi Standard Treatment Guidelines, 4th Edition. 2009. (http://apps.who.int/ medicinedocs/documents/s18801en/s18801en.pdf). 4 Republic of Malawi, Ministry of Health, Health Education Unit. Guidelines for Family Planning Communication. April 2011. (https://www.c-changeprogram.org/sites/default/files/Malawi_ Guidelines_for_FP_Comm_April_2011_FINAL_website_0.pdf). 5 Republic of Malawi. Ministry of Health and IntraHealth International. Preservice Education Family Planning Reference Guide. 2010. (http://www.intrahealth.org/page/preservice-education-family- planning-reference-guide). 6 Republic of Malawi. Ministry of Health. National Reproductive Health Strategy 2006-2010. 7 Republic of Malawi, Ministry of Health. Guidelines for Provision of Comprehensive services for survivors of physical and sexual violence at Health Facilities in Malawi (One-Stop Centres). Revised Edition 2012. http://www.svri.org/OSCGuidelines.pdf. 8 Malawi Human Rights Resource Centre, Malawi Police Service and Malawi Ministry of Health. Testing the feasibility of police provision of emergency contraception in Malawi. August 2012. (http://www.svri. org/MHRRCEVALUATIONREPORT.pdf). 9 Chimwaza, Wanangwa. Personal Correspondence. 24 January 2014. 10 ICEC Status and Availability Database. Retrieved 9 October 2013, from http://www.cecinfo.org/country-by-country-information/status- availability-database/countries/malawi/. 11 United Nations Development Programme. Anti-counterfeit laws and public health: What to look out for. 2011. (http://www.aidsdatahub. org/sites/default/files/documents/Anti-counterfeit_Laws_and_ Public_Health.pdf). 12 Securing Industry. Interpol seizes illicit drugs in African campaign. 10 October 2013. Accessed 13 December 2013, from http://www. securingindustry.com/pharmaceuticals/interpol-seizes-illicit-drugs- in-african-anti-counterfeit-campaign/s40/a1854/. 13 Interpol. Pharmaceutical Crimes: Operations. 10 October 2013. Accessed 13 December 2013, from http://www.interpol.int/Crime- areas/Pharmaceutical-crime/Operations/Operation-Giboia. 14 Banja La Mtsogolo. Retrieved 12 December 2013, from http://www.banja.org.mw/. 15 Integrated Regional Information Networks. Growing Demand for Family Planning in Malawi. 31 January 2013. Accessed 12 December 2013, from http://www.irinnews.org/report/97377/growing- demand-for-family-planning-in-malawi. 16 Chimwaza, Wanangwa. Personal Correspondence. 7 February 2014. 17 RHInterchange. Malawi-Summary of Shipments. Retrieved 31 March 2014, from http://www.myaccessrh.org/rhi-home?p_p_id =rhiuserportlet_WAR_rhiportlet&p_p_lifecycle=1&p_p_state= normal&p_p_mode=view&p_p_col_id=column-1&p_p_col_count=1& _rhiuserportlet_WAR_rhiportlet__spage=%2Fshipmentsummary. do&_rhiuserportlet_WAR_rhiportlet__sorig=%2Fshipmentsummary.do. This fact sheet has been prepared by the International Consortium for Emergency Contraception and represents the best information we have been able to gather. We welcome your input for future revisions. Please contact us at info@cecinfo.org. Visit our website at www.emergencycontraception.org for more information on EC.

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