UTILIZATION OF FAMILY-PLANNING-SERVICES AT THE TEACHING HOSPITAL IN BLANTYRE, MALAWI

In the whole of 1993, there were a total of 1533 new clients who atten ded the family planning clinic at the Queen Elizabeth Central Teaching Hospital in Blantyre, Malawi. They formed 23.0% of the total client-v isits for the year, 305 women had surgical contraception (bilateral tu bal ligation) for various reasons, but mainly on request for family li mitation. The ages of the new clients ranged from 15 to 49 years. Adol escents (< 20 years olds) formed only 9.0%, while those aged > 35 year s formed 22.0%. Their parity ranged from 0 to 11, with 58.0% of them b eing para 1 to 4. The grandmultiparae (para > 5) formed 31.0%. The ora l pill was the most favoured method (42.0%), followed by depo-provera (31.0%) and, sterilisation (21.0%). Though the majority of the clients who chose the oral pill were aged less than 30 years, about 6.0% were aged > 35 years. Likewise about 15.0% of those who took oral pills we re para > 5, i.e. grandmultiparae. These are women who should have eit her stopped producing a long time back or been counselled to have tuba l ligation rather than these temporary methods, when seen in the clini c then. Amongst all the client-visits for the year, oral pill and depo -provera were the two most popular methods, 42.0% and 41.0%, respectiv ely. The ratio, between the clients who discontinued the method they w ere on and the new clients was 1:6.8, and that of drop-out/new clients was 1:2.4, which are quite high. The rate of absenteeism was also hig h at 29.0% of the total client-visits. Most of the ones discontinuing a method (53%) were on IUCD, and the main reason for doing so was to c onceive again (48.0%). 8.0% of them had already conceived while on a m ethod, of whom 77.0% had been on oral pills. Though 319 clients were c ounselled and chose surgical contraception, there were only 305 women who had the procedure done for the whole year, out of whom only 68.(22 .0%) were interval procedures, Not all of these had been counselled in the family planning clinic. The implications of these results and rel ated issues are discussed and further strategies for improvement sugge sted.