title: Why people don't use family planning: how different methods of enquiry elicit different responses.
abstract: BACKGROUND
  Engaging community, government and non-governmental organisation (NGO) stakeholders in the design of family planning (FP) programmes is best practice. Stakeholders can provide local insights on barriers to FP. However, it can be difficult to know whether there may be limited programme perceptions if only one method of enquiry is used.
  
  
  OBJECTIVE
  This study aimed to validate the perceptions of stakeholders on barriers to FP in Malawi.
  
  
  METHODS
  The study was conducted in a rural area in Lilongwe District, Malawi and employed a mixed-methods exploratory design. Five focus groups were run with community, government and NGO stakeholders to identify barriers to using modern FP. The results of the qualitative phase were then compared using a quantitative survey of 960 women who had at least one child aged under 5 years.
  
  
  RESULTS
  The qualitative phase identified a range of barriers to FP, including lack of awareness, lack of access, religious beliefs, myths, and opposition by husbands. However, the quantitative survey found that these issues are not a concern for the majority of women. The main reasons given by women for not using FP were that were not currently having sex or had a child recently, and so they felt they did not need to use it.
  
  
  CONCLUSIONS
  Perceptions of stakeholders from a qualitative approach do not necessarily reflect the perspectives of the population as documented in a quantitative survey. When involving stakeholders it is important to recognise that different approaches may elicit different responses, particularly with regard to sensitive issues or issues that apply to particular subgroups. Consequently, a deeper understanding is likely to be obtained by using a multimethod approach.
authors.affiliation: Program Manager, Inter Aide, Lilongwe, Malawi.
authors.forename: Piroska
authors.initials: P
authors.lastname: Bisits-Bullen
authors.affiliation: Public Health Consultant, Lilongwe, Malawi.
authors.forename: Precious
authors.initials: P
authors.lastname: Phiri
authors.affiliation: Public Health Consultant, Lilongwe, Malawi.
authors.forename: Sam
authors.initials: S
authors.lastname: Chirwa
authors.affiliation: Public Health Consultant, Lilongwe, Malawi.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Chauwa
keywords: Malawi; education and training; ethnic minority and cultural issues; family planning service provision; health knowledge, attitudes, practice; qualitative research