In the whole of 1993, there were a total of 1533 new clients who attended the family planning clinic at the Queen Elizabeth Central Teaching Hospital in Blantyre, Malawi. They formed 23.0% of the total client-visits for the year. 305 women had surgical contraception (bilateral tubal ligation) for various reasons, but mainly on request for family limitation. The ages of the new clients ranged from 15 to 49 years. Adolescents (< 20 years old) formed only 9.0%, while those aged > 35 years formed 22.0%. Their parity ranged from 0 to 11, with 58.0% of them being para 1 to 4. The grandmultiparae (para > 5) formed 31.0%. The oral 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 were para > 5, i.e. grandmultiparae. These are women who should have either stopped producing a long time back or been counselled to have tubal ligation rather than these temporary methods, when seen in the clinic 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%, respectively. The ratio, between the clients who discontinued the method they were 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 high at 29.0% of the total client-visits.(ABSTRACT TRUNCATED AT 250 WORDS)
PIP: 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.