Exploring Challenges Faced by Nurses on Provision of Hormonal Contraceptives to Women on Antiretroviral Therapy in Selected Healthcare Facilities in Lilongwe District, Malawi

Abstract

Background

Malawi is a low-income country with a high maternal mortality rate, unmet need for family planning and high reports (41%) of unintended pregnancies. Women on Antiretroviral Therapy (ART) continued to experience unintended pregnancies after using hormonal contraceptives provided by nurses in the family planning clinics. However, the unintended pregnancies could affect the sexual and reproductive health of women and decisions of nurses on contraceptive provision to women on ART.

Objective

The purpose of the study was to explore challenges faced by nurses in the provision of hormonal contraceptives to women on ART in selected clinics in Lilongwe, Malawi.

Methods

A qualitative approach using an explorative design was used in this study. Eight (8) participants were selected purposefully from five public family planning clinics in Lilongwe. They were interviewed individually using a semi-structured interview guide. Data were analyzed using a content analysis guide.

Results

Three themes emerged from the data and these were as follows: limited knowledge of nurses; inadequate resources and inadequate support. Results revealed that nurses had limited knowledge of contraceptives to provide to women on ART due to lack of ART content in the contraceptive training which they had. They also lacked clinical and human resources and adequate time to teach clients which affected provision of the right hormonal contraceptives to women on ART. Furthermore, they needed support in the form of supervision, reference materials and integration of ART and contraceptive provision services.

Conclusion

The challenges that nurses faced had an influence on the provision of contraceptives to women on ART. The study recommends that nurses should be trained on the provision of contraceptives to women on ART and be provided with the required resources and support for proper care to be achieved. Furthermore, there is a need for clear guidelines on hormonal contraceptives that women on ART could get and the integration of ART and family planning services.

Keywords:

• antiretroviral therapy
• hormonal contraceptives
• unintended pregnancies
• nurses
• challenges

Acknowledgments

The authors acknowledge with gratitude the Norwegian government for financial support through Kamuzu College of Nursing (now known as Kamuzu University of Health Sciences), the management and staff of the five research sites and also the study participants.

Author Contributions

All authors contributed towards the following: conception and design of the study, data collection, analysis and interpretation, identification of the journal and revising the paper and agree to be accountable for all aspects of the work. At the time of the study, Kamuzu College of Nursing was a constituent college of University of Malawi and College of Medicine was also a constituent college of University of Malawi which have now merged and are called Kamuzu University of Health Sciences. College of Medicine Research and Ethics Committee was the approval body that was used for all health-related research under the University of Malawi which approved this study.

Disclosure

Mrs Enalla Thombozi reports grants from NORHED, during the conduct of the study. The authors declare that they have no other conflicts of interest in this work.