Influence of integrated services on postpartum family planning use: a cross-sectional survey from urban Senegal

Abstract

BackgroundAlthough the majority of postpartum women indicate a desire to delay a next birth, family planning (FP) methods are often not offered to, or taken up by, women in the first year postpartum. This study uses data from urban Senegal to examine exposure to FP information and services at the time of delivery and at child immunization appointments and to determine if these points of integration are associated with greater use of postpartum FP.MethodsA representative, household sample of women, ages 15–49, was surveyed from six cities in Senegal in 2011. This study focuses on women who were within two years postpartum (n = 1879). We also include women who were surveyed through exit interviews after a visit to a high volume health facility in the same six cities; clients included were visiting the health facility for delivery, post-abortion care, postnatal care, and child immunization services (n = 794). Descriptive analyses are presented to examine exposure to FP services among postpartum women and women visiting the health facility. Logistic regression models are used to estimate the effect of integrated services on postpartum FP use in the household sample of women. Analyses were conducted using Stata version 12.ResultsAmong exit interview clients, knowledge of integrated services is high but only a few reported receiving FP services. A majority of the women who did not receive FP services indicated an interest in receiving such information and services.Among the household sample of women up to two-years postpartum, those who received FP information at the time of delivery are more likely to be using modern FP postpartum than their counterparts who also delivered in a facility but did not receive such information. Exposure to FP services at an immunization visit was not significantly related to postpartum FP use. Another key finding is that women with greater self-efficacy are more likely to use a modern FP method.ConclusionThis study’s findings lend strong support for the need to improve integration of FP services into maternal, newborn, and child health services with the goal of increasing postpartum women’s use of FP methods in urban Senegal.

Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries

“…This is true even among self-reported LAM users: a recent analysis of DHS data showed that many did not adhere to all three criteria for LAM effectiveness at the time of the survey [29]. Nevertheless, when postpartum women are exposed to postpartum family planning messages during other visits to health facilities, such as during labor and delivery, they are more likely to adopt a modern method [30,31]. In addition, community-based programs can increase the use of effective contraceptive methods in the postpartum period [32].…”

Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India

“…Prior use of contraception was associated with postpartum contraception utilization which suggests that if women are educated about family planning options prior to pregnancy, this may improve their utilization postpartum for birth spacing [5]. Future interventions should also incorporate husbands since talking to husbands about family planning postpartum was associated with greater contraceptive utilization.…”

Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

“…Policy and programming recommendations that promote integrating family planning and child immunization services are often based on insubstantial or con icting evidence about its impact on health services delivery and patient outcomes (20)(21)(22)(23). Given the scarcity of evidence and the resource and planning implications of integration, it is critical to develop context speci c evidence that captures the nature, extent, and effects of integration in order to inform policy and program design (9).…”

“…Additionally, we reviewed the integration literature to identify facility-level attributes that support service integration. Several critical attributes emerged, including a) facility norms that support concurrent service provision (e.g., operational management standards and procedures that support the availability of both child immunization and family planning services at the same consultation or on the same day), and b) provider capacity to offer multiple services (e.g., provider(s) has the skills and willingness to offer family planning information or services during a child immunization visit) (22,26,(33)(34)(35)(36).…”