Sexual Pleasure, Partner Dynamics and Contraceptive Use in Malawi.

CONTEXT Despite increases in the use of modern contraceptives, Malawian women have a high unmet need for contraception. Because current understanding of contraceptive use ignores sexual pleasure and partner dynamics, this study explores the links between sexual pleasure seeking, partner dynamics and contraceptive use. METHODS As part of a larger qualitative study conducted in 2012, 23 focus group discussions among married women and men and 10 in-depth interviews with service providers were conducted with a total of 192 participants in two districts of Malawi. Thematic analysis was performed to identify recurrent categories and patterns. RESULTS Method choice and consistent use were affected by the quantity and quality of sex desired and, most important, by any perceived change in sexual pleasure for respondents or their partner. For women, more so than for men, experiences of sexual pleasure were intertwined with gender norms, women's perceived role of providing pleasure in sexual relationships and the relationship dynamics this generated. These partner dynamics ultimately created a formidable barrier to contraceptive use or promoted contraceptive discontinuation. CONCLUSION Family planning programs should consider the nuanced ways in which notions of sexual pleasure, partner dynamics and the broader social context are involved in decision making regarding contraceptive use.