Modeling Contraception and Pregnancy in Malawi: A Thanzi La Onse Mathematical Modeling Study

Tim Colbourn, Eva Janoušková, Ines Li Lin, Joseph Collins, Emilia Connolly, Matt Graham, Britta Jewel, Fannie Kachale, Tara Mangal, Gerald Manthalu, Joseph Mfutso-Bengo, Emmanuel Mnjowe, Sakshi Mohan, Margherita Molaro, Wingston Ng'ambi, Dominic Nkhoma, Paul Revill, Bingling She, Robert Manning Smith, Pakwanja TweaAsif Tamuri, Andrew Phillips, Timothy B Hallett

Research output: Contribution to journalArticlepeer-review


Malawi has high unmet need for contraception with a costed national plan to increase contraception use. Estimating how such investments might impact future population size in Malawi can help policymakers understand effects and value of policies to increase contraception uptake. We developed a new model of contraception and pregnancy using individual-level data capturing complexities of contraception initiation, switching, discontinuation, and failure by contraception method, accounting for differences by individual characteristics. We modeled contraception scale-up via a population campaign to increase initiation of contraception (Pop) and a postpartum family planning intervention (PPFP). We calibrated the model without new interventions to the UN World Population Prospects 2019 medium variant projection of births for Malawi. Without interventions Malawi's population passes 60 million in 2084; with Pop and PPFP interventions. it peaks below 35 million by 2100. We compare contraception coverage and costs, by method, with and without interventions, from 2023 to 2050. We estimate investments in contraception scale-up correspond to only 0.9 percent of total health expenditure per capita though could result in dramatic reductions of current pressures of very rapid population growth on health services, schools, land, and society, helping Malawi achieve national and global health and development goals.

Original languageEnglish
Pages (from-to)585-607
Number of pages23
JournalStudies in family planning
Issue number4
Publication statusPublished - 21 Dec 2023

Bibliographical note

© 2023 The Authors. Studies in Family Planning published by Wiley Periodicals LLC on behalf of Population Council.


  • Pregnancy
  • Female
  • Humans
  • Malawi
  • Contraception
  • Family Planning Services
  • Health Services
  • Postpartum Period
  • Contraception Behavior

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