What is driving Malawi's reproductive health gains, and who is still being left behind?

This two-page policy brief summarises findings from a peer-reviewed study published in BMC Public Health: "Trends and socioeconomic inequalities in contraceptive use, skilled birth attendance, and fertility in Malawi (2015–2024)" (DOI: 10.1186/s12889-026-28516-5) The study analysed nationally representative data on 46,149 women aged 15 to 49 from the 2015–16 and 2024 Malawi Demographic and Health Surveys (MDHS) to examine trends in modern contraceptive use, skilled birth attendance, and fertility, and their socioeconomic patterning. A Blinder–Oaxaca decomposition was used to identify the drivers of change in contraceptive use. Key findings: modern contraceptive use rose from 45% to 53%, with relatively larger gains among poorer women. Decomposition analysis shows the increase was driven almost entirely by changes in behaviour, access and programme effectiveness rather than by shifts in the population's education or wealth composition. Skilled birth attendance rose from 90.5% to 96.2% but remains strongly stratified by education and wealth. Fertility continues to decline across socioeconomic groups. The brief translates these findings into four recommendations for policymakers and programme teams in Malawi: protecting family planning budget lines and commodity supply, sustaining community-based delivery models, targeting maternal health investment at the least educated and poorest women, and monitoring equity alongside national averages. Intended audience: policymakers, programme managers, and advocacy organisations working on reproductive, maternal and child health in Malawi.