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.