The Impact of Poverty on Family Planning Decisions in Rural Malawi

Background and Purpose: Scholars have identified a “scarcity mindset” which influences decision making. Individuals experiencing scarcity - being short on money, time, or other resources - tend to have a specific focus on short-term needs, often neglecting more general and/or long-term needs. This study examined whether, in rural Malawi, poverty impacts women's priorities and thought processes on family planning and sexual health decisions.

Method: Working with trained Malawian research assistants, four focus group discussions (FGDs) of 8-12 women per group and 21 semi-structured, in-depth interviews (IDIs) were conducted in a rural community outside Lilongwe, Malawi. Study participants were drawn from the community where our program, Umoyo wa Thanzi (UTHA) is based. The sample (n=61) is predominately women between the ages of 25 and 45 (41%) and between the ages of 18 and 24 (39%), and the majority were either married (41%) or single (30%). FGDs and IDIs were recorded and translated into English. Translated transcriptions were coded and analyzed with NVivo 10 for themes relating to poverty and sexual health decision making. Analysis was guided by the principles of grounded theory and the constant comparative method.

Results: Three major themes emerged from analysis. First, women make family planning and sexual health decisions on a daily basis, and these choices are often influenced by financial constraints. Women described how choices in family size affect socioeconomic status, and these choice vary with wealth strata. Second, some women demonstrated the "scarcity mindset", prioritizing basic needs, such as food and clothing, over family planning or long-term needs. Some women had sexual partners to provide familial support and stability, although others identified this as being harmful. Third, several narratives emerged that complicated this decision-making approach. For example, some women used sex work as an economic strategy, but acknowledge that sexual contact with multiple partners can lead to HIV, resulting in inadequate care for their children.

Implications: Family planning and sexual health decisions have important financial repercussions. Decision-making is constrained in the context of poverty, and a scarcity mindset was observed in women's descriptions of their sexual health decisions. Nevertheless, constraints and decision making in this rural context are multi-directional with regards to family planning and sexual behavior. Findings highlight the impact of poverty on family planning decisions, and therefore, future research should explore interventions for access to family planning services in rural settings. Social workers are uniquely adept to provide international social services to underserved populations and consequently, should be engaged in international family planning issues.