Meeting Postpartum Women’s Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda

Dulli, Lisa; Eichleay, Marga; Rademacher, Kate H.; Sortijas, Steve; Nsengiyumva, Theophile

doi:10.9745/ghsp-d-15-00291

Cited by 67 publications

(82 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This realist evaluation sought to identify key mechanisms driving the implementation of an intervention of integrated childhood immunisation and FP services in BGRS, Ethiopia. It contributes to a growing body of literature that seeks to understand uptake of MCMs when FP services are integrated with other health services (7)(8)(9)(23)(24)(25)(26). Recent studies from Rwanda, Zambia, and Ghana have looked speci cally at the integration of FP with immunisations services and have found varying levels of success (7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Krishnaratne

Hamon

Hoyt

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Maternal and child health are key priorities among the Sustainable Development Goals , which include a particular focus on reducing morbidity and mortality among women of reproductive age, newborns, and children under the age of five. Two key components of maternal and child health are family planning (FP) and immunisation. Providing these services through an integrated delivery system could increase the uptake of vaccines and modern contraceptive methods (MCMs) particularly during the post-partum period. Methods: A realist evaluation was conducted in two woredas in Ethiopia to determine the key mechanisms and their triggers that drive successful implementation and service uptake of an intervention of integrated delivery of immunisations and FP. This evaluation included the: 1) development of an initial programme theory; 2) review of relevant published theories; 3) analysis of project monitoring data; 4) analysis of qualitative data from 23 semi-structured interviews to determine key mechanisms and drivers; and 5) development of a revised programme theory comprised of context-mechanism-actor-outcome and context-mechanism-intervention-actor-outcome configurations based on empirical findings. Results: The proportion of women who brought their children for immunisation and received MCMs was 63.0% (4,260/6,764) overall [74.3% (2,944/3,961) in Assosa woreda and 46.9% (1,316/2,803) in Bambasi woreda]. Key contextual factors identified were: a strong belief in values among religious leaders and community members that challenged FP; a lack of support for FP from male partners based on religious values; and the use of trained Health Extension Workers (HEWs) to deliver FP services. Within these contexts, intervention components that focused on the alignment of religious texts with FP, the promotion of FP by religious leaders, and the training of HEWs and health care workers on FP counselling and service delivery, influenced the implementation of the intervention and triggered several mechanisms of acceptability, access, and adoption of innovations. Conclusions: Linking context and intervention components to the mechanisms they triggered helped explain the intervention outcomes, and more broadly how and for who the intervention worked. This enabled the development of a programme theory that could be used to inform the integrated delivery of FP services in similar contexts.

show abstract

Section: Discussionmentioning

confidence: 99%

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Krishnaratne

Hamon

Hoyt

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Integrating contraceptive services into infant immunization services was effective, acceptable, and feasible without negatively affecting immunization uptake (Dulli et al. ).…”

Section: Discussionmentioning

confidence: 99%

Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

Willcox¹,

King²,

Fall³

et al. 2019

Studies in Family Planning

View full text Add to dashboard Cite

Health workers have received training on delivering postpartum long-acting reversible contraceptives (LARCs) through several projects in Uganda, yet uptake still remains poor. To understand the reasons, and to gather suggestions for improving uptake, we conducted individual semi-structured interviews with a total of 80 postpartum parents, antenatal parents, health workers, and village health teams in rural south-west Uganda. Interviews were recorded, transcribed, translated, and analyzed using qualitative thematic analysis. Specific barriers to uptake of immediate postpartum contraception for women included: the need to discuss this option with their husband, the belief that time is needed to recover before insertion of a LARC, and fear that the baby might not survive. Furthermore, social consequences of side-effects are more serious in low-income settings. Suggestions for improving uptake of postpartum contraception included health education by "expert users," couples counseling during antenatal care, and improved management of side-effects.

show abstract

“…Among the various focus areas of MCHIP are: (1) increasing postpartum contraceptive use through IUD insertion immediately after a birth, and (2) strengthening routine immunization services and delivery [35-36]. Integration of these different programs – postpartum family planning counseling during antenatal visits, insertion of IUDs soon after delivery, along with routine immunization visits, could open a valuable opportunity to provide a continuum of care to pregnant and postpartum women [34]. …”

Section: Discussionmentioning

confidence: 99%

Counseling During Maternal and Infant Health Visits and Postpartum Contraceptive Use in Uttar Pradesh, India

Rajan¹,

Speizer²,

Calhoun³

et al. 2016

International Perspectives on Sexual and Reproductive Health

View full text Add to dashboard Cite

Context Postpartum family planning is a compelling concern of global significance due to its salience to unplanned pregnancies, and to maternal and infant health in developing countries. Yet, women face the highest level of unmet need for contraception in the year following a birth. A cost-effective way to inform women about their risk of becoming pregnant after the birth of a child is to integrate family planning counseling and services with maternal and infant health services. Methods We use recently collected survey data from 2733 women from six cities in Uttar Pradesh, India who had a recent birth (since 2011) to examine the role of exposure to family planning information at maternal and infant health visits on (1) any contraceptive use in the postpartum period, and (2) choice of modern method in the postpartum period. We use discrete-time event history multinomial logit models to examine the duration to contraceptive use, and choice of modern method, in the 12 months following the last birth since 2011. Results We find that receiving counseling in an institution at the time of delivery has the strongest influence on women’s subsequent uptake of modern contraception (female sterilization and IUD). Being visited by a CHW in the extended postpartum period was also strongly associated with subsequent uptake of modern contraception (IUD, condom and hormonal contraception). Conclusion Providing postpartum family planning counseling at key junctures during maternal health visits has the potential to increase uptake of modern contraceptive method in urban Uttar Pradesh.

show abstract

Meeting Postpartum Women’s Family Planning Needs Through Integrated Family Planning and Immunization Services: Results of a Cluster-Randomized Controlled Trial in Rwanda

Cited by 67 publications

References 18 publications

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Barriers to Uptake of Postpartum Long‐Acting Reversible Contraception: Qualitative Study of the Perspectives of Ugandan Health Workers and Potential Clients

Counseling During Maternal and Infant Health Visits and Postpartum Contraceptive Use in Uttar Pradesh, India

Contact Info

Product

Resources

About