Mixed methods study of an HIV/life skills project for women in Malawi

DETAILED SUMMARY

Importance

• Malawi has one of the highest maternal mortality rates in the world, where one out of every 36 women dies due to pregnancy-related complications. Despite having made significant progress over the last 25 years, the 2015 maternal mortality ratio is 510/100,000 live births, significantly higher than the Millennium Development Goal target of 280. Adolescents are estimated to account for 20% of maternal mortality in Malawi.

Objective

• To reduce maternal morbidity and mortality through high quality maternal and reproductive health services, family planning services, and increased government capacity in the Nkhotakota district over a 3 year timeframe in Malawi.

Study details

• Study design: Mixed methods
• Data collection tools: Desk review of monitoring data and project documents; interviews (6) with District Health Office staff; and focus group discussions (9) with key project staff, partners and beneficiaries
• Participants: 33,515 women, key project staff, partners and beneficiaries
• Implementation setting: Women living in three of seven traditional areas in Malengachanzi, Mwadzama, and Mwansambo
• Study period: November 2012 – March 2016

Intervention

• Other (Concern Maternal and Reproductive Health Project): Multi-session HIV and life skills curriculum delivered by paired male/female coaches to young women aged approximately 10–19, with a complementary SKILLZ Malawi component for mixed-gender youth.

Results

• Overall improvements: Comparison of the recent (Feb 2016) endline survey with that at midterm (May 2015) reflects substantial improvements in the consumption of iron tablets for 90 days during the last pregnancy (10% to 22% among mothers of children 0-23 months); discussing family planning (FP) with a field worker or at a health facility in the past year (27% to 43% among women 15-49 years); and knowledge of emergency transport (45%-69% among women 15-49 years)
• Knowledge of danger signs: The percentage of women aged 15-49 years with correct knowledge of at least two maternal danger signs increased from 34% at baseline to 65% at endline, and the percentage of women aged 15-49 years with correct knowledge of at least two newborn danger signs increased from 23.5% at baseline to 71% at endline
• Knowledge of family planning methods: The percentage of women with correct knowledge of family planning methods increased from 82% of 15-49 year olds at midterm to 95% at endline
• Participation: The percentage of women aged 15-49 and 15-19 who attended a village meeting in the previous 3 months where sexual and reproductive health (SRH) issues were discussed (14% of those aged 15-49 years at midterm increasing to 22% at endline)

Conclusions and implications

• The project made valuable, measurable progress across all three strategic objectives (health services, family planning, and governance capacity), but important gaps remain—especially around family planning uptake and postnatal care among younger women—signaling a continued need for targeted investment in this district.