Leveraging the Power of Markets for Family Planning Services: A Look at PSI/Malawi’s Approach to Social Franchising

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Despite a heavy burden of disease (e.g., malaria, HIV/AIDS and tuberculosis), high rates of poverty, chronic shortage and unequal distribution of health workers and vulnerability to climate conditions and changes, Malawi has made significant gains in critical health indicators in recent years. For example, maternal mortality declined from 807/100,000 live births in 200610 to 460/100,000 in 2012,11 and under-five child mortality has fallen from 133/1,000 live births to 83/1,000 in 2012.12 In addition, Malawi is on track to achieve five of its eight Millennium Development Goals, including those related to sexual and reproductive health.

Evidence shows that increasing contraceptive use and reducing unmet need leads to reductions in maternal and under-five child mortality.13 In Malawi, recent achievements in expanding access to and use of voluntary modern contraception have resulted in a modern contraceptive prevalence rate of 42% among married women (2010), up from 28% in 2004. This is a remarkable increase, making Malawi one of the greatest family planning success stories of the last decade.

Among other factors, high-level political commitment, improved family planning policies and expanded product and service delivery approaches have contributed to these achievements. In 2006, the Malawi government embraced family planning as essential to attaining its health Millennium Development Goals.14 More recently, as part of the global movement Family Planning 2020,15 the Government of Malawi committed to raising the national modern contraceptive prevalence rate to 60% by 2020, with a major focus on youth.