2 Million and Counting: Contraception and the Community

2 Million and Counting: Contraception and the Community


In 2017, nearly 2 million women in Malawi were using a modern method of contraception. By ensuring women have access to contraception, we can avert unintended pregnancies, unsafe abortion, and maternal deaths. Essentially, contraception can save lives.

What is CARE doing to help enable access and voluntary use of contraception in Malawi and the places where we work? CARE has been using the Community Score Card© (CSC) to help improve maternal and reproductive health outcomes and in a recent evaluation found that the CSC had a significant effect on use of modern contraception in the communities that participated in the CSC process (than those that did not).

So, how does the CSC work?

The CSC enables communities, health providers, and local government leaders to come together to identify service utilization and provision challenges, to generate local solutions to these challenges, and to implement and track the effectiveness of those solutions. CARE evaluated the CSC in the Ntcheu district of Malawi, to see how effective this tool was in improving maternal and reproductive health-related outcomes. The findings were published in the journal PLoS ONE.

What did we accomplish?

  • Contraceptive use went up: Contraception use was 57% greater in communities that participated in the CSC process than in those that did not. 
  • Pregnant women are getting better care: Pregnant women in CSC communities experienced a 20% greater increase in visits from community health workers (CHWs) than did those in the comparison areas – dramatically improving their access to care close to home.  
  • Men are more involved: Although everyone can benefit from access to family planning methods and sexual and reproductive health care (SRH), men often see these issues as irrelevant to their lives. Male involvement in reproductive health and family planning decisions increased 33 percentage points in CSC communities after two years of the process.

How did we get there?

  • Asked communities what they needed: CARE Malawi convened focus group discussions with community members to identify and prioritize barriers they faced in accessing SRH services.
  • Engaged health providers: CHWs, clinic administrators, and other health care providers were separately invited to discuss issues related to delivering quality services.
  • Created space for dialogue: Community members and service providers, came together, with local government, to share their identified barriers and priorities. From there, they worked with local government to collectively develop solutions and create an action plan to address issues that were expressed.
  • Tracked progress: Once an action plan was developed, community members, service providers, and local government began to make the agreed-upon improvements. Indicators – which were developed together – are used to measure progress.
  • Continued the process: Every six months, communities came back together to discuss their challenges and progress, creating an ongoing cycle of problem identification, solution generation, implementation of improvements, and mutual accountability.
  • Included youth in the conversation: CARE invited youth groups to participate in the CSC process. They have since self-organized and implemented the CSC across various communities in the Ntcheu district of Malawi, addressing a wide variety of issues from solar energy to early marriage.

Want to learn more?
Results from the randomized controlled study are available through PLoS ONE online, and supplemental information, including toolkits, case studies, and guidance documents, are available on CARE.org. A series of short films depicting participants in CARE’s CSC program in Malawi, as well as a brief infographic explaining how the CSC works, are available online at raisingthescore.org.

Special thanks
Thanks to the Sall Family Foundation for funding this research study, which took place between 2012-2014.

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