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The contraceptive Prevalence Rate (CRP) in sub-Saharan Africa (SSA) more than doubled over the past three decades, from 13% in 1990 to 29% in 2019. But the sub-region still has the lowest CPR and highest fertility in the world. Malawi is one of the few exemplary SSA countries that achieved a remarkable increase in modern Contraception Prevalent Rate (mCPR), from 6% in 1992 to 45% in 2015-16.

Dr Eliya Zulu, AFIDEP’s Executive Director, shared the Exemplar Project in Family Planning (FP) at the recent International Conference on Family Planning, zeroing in especially on Malawi’s success story. The Exemplars in FP project explores drivers of change and the timing of significant policies, events, and inputs that changed the trajectory of FP demand and modern contraceptive uptake in selected positive outlier countries (Kenya, Senegal, and Malawi).

The Malawi in-country deep dive study Examines drivers of success and their relative contributions to FP access and utilization; the role of politics, leadership, international agencies, and other ecological factors in the implementation of the FP program; and the relative role of health versus non-health, and private versus public sector delivery. Unpacking the key factors that contributed to accelerated FP progress in Malawi will showcase an action-oriented, data-driven way to support decision-makers and drive further advancement in FP in similar settings. As such the key drivers of change are linked to the trajectory of contraceptive uptake to highlight important lessons for the global FP community.

Dr Zulu presented the preliminary results on drivers of exemplary change in contraception use and demand satisfied in Malawi, at the ICFP. The discussion explored major drivers of socioeconomic change, key policies, strategies, and programs implemented over the last three decades. He highlighted that Malawi’s success results from a mix of things: formulation and implementation of important policies and strategies, successful family planning program implementation, and increased global attention and financing for family planning. Child survival also improved over the years due to advancements in maternal and child health interventions. As such, the need to have many children decreased, leading to increased demand for contraceptives. Improvements in educational attainments and gender equality have also translated to increased contraceptive uptake.

It is worth noting that with improved educational attainment and increased contraceptive uptake, women often desire and have fewer children. However, although educational attainment has increased, enrolment rates in secondary and higher institutions of learning are still low in Malawi. Thus, despite improvements in contraceptive use, women still have more children than they want.

The Institute of Global Health and Development at Aga Khan University (AKU) is the project lead. The Bill & Melinda Gates Foundation (BMGF) is funding the project in collaboration with the Exemplars in Global Health (EGH) program, incubated at Gates Ventures (GV). The African Institute for Development Policy (AFIDEP) leads the Malawi Country study.

In a related development, AFIDEP is also partnering with the Exemplars in Global Health Programme at Gates Ventures, University of Portsmouth and University of Southampton in the Exemplars in Adolescent Sexual and Reproductive Health (ASHER) project. The ASHER project seeks to identify drivers of success in reducing and managing teenage pregnancies and improving overall adolescent sexual and reproductive health in four positive outlier countries (Cameroon, Malawi, Ghana, and Rwanda). The countries were identified on the basis of their progress in reducing and managing teenage pregnancies and improving the overall adolescent sexual and reproductive health and rights.

In each of the positive outlier countries, an in-country research partner leads the in-country research. AFIDEP is leading the Malawi in-country research. The lessons from the positive outlier countries will be shared with other countries in the region and globally.