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Why people don’t use family planning: how different methods of enquiry elicit different responses
  1. Piroska Bisits-Bullen1,
  2. Precious Phiri2,
  3. Sam Chirwa2,
  4. Lloyd Chauwa2
  1. 1Program Manager, Inter Aide, Lilongwe, Malawi
  2. 2Public Health Consultant, Lilongwe, Malawi
  1. Correspondence to Dr Piroska Bisits-Bullen, Inter Aide, P. O. Box 31405 Lilongwe, Malawi; piroska.bisitsbullen{at}


Background Engaging community, government and non-governmental organisation (NGO) stakeholders in the design of family planning (FP) programmes is best practice. Stakeholders can provide local insights on barriers to FP. However, it can be difficult to know whether there may be limited programme perceptions if only one method of enquiry is used.

Aim This study aimed to validate the perceptions of stakeholders on barriers to FP in Malawi.

Methods The study was conducted in a rural area in Lilongwe District, Malawi and employed a mixed-methods exploratory design. Five focus groups were run with community, government and NGO stakeholders to identify barriers to using modern FP. The results of the qualitative phase were then compared using a quantitative survey of 960 women who had at least one child aged under 5 years.

Results The qualitative phase identified a range of barriers to FP, including lack of awareness, lack of access, religious beliefs, myths, and opposition by husbands. However, the quantitative survey found that these issues are not a concern for the majority of women. The main reasons given by women for not using FP were that were not currently having sex or had a child recently, and so they felt they did not need to use it.

Conclusions Perceptions of stakeholders from a qualitative approach do not necessarily reflect the perspectives of the population as documented in a quantitative survey. When involving stakeholders it is important to recognise that different approaches may elicit different responses, particularly with regard to sensitive issues or issues that apply to particular subgroups. Consequently, a deeper understanding is likely to be obtained by using a multimethod approach.

  • family planning service provision
  • ethnic minority and cultural issues
  • education and training
  • qualitative research
  • Malawi
  • health knowledge, attitudes, practice

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  • Twitter Follow Piroska Bisits-Bullen at @piroskabb

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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