Successful Proof of Concept of Family Planning and Immunization Integration in Liberia

Cooper, Chad J.; Fields, Rebecca; Mazzeo, Corinne I.; Taylor, Nyapu D; Pfitzer, Anne; Momolu, Mary; Jabbeh-Howe, Cuallau

doi:10.9745/ghsp-d-14-00156

Cited by 45 publications

(57 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Given their high unmet need and the benefits of longer interpregnancy intervals, postpartum women should be encouraged to use contraception as much as, if not more than, non-postpartum women, and barriers to use should be studied further. In Liberia, for example, formative research has uncovered a cultural taboo around sexual activity before "a baby walks" that restricts postpartum family planning uptake [25].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

Self Cite

View full text Add to dashboard Cite

Objectives: To analyze data from recent Demographic and Health Surveys (DHS) conducted in 21 low-and middle-income countries (LMICs) to examine patterns of interpregnancy intervals, unmet need, pregnancy risk and family planning method use and method mix among women 0-23 months postpartum. Study design: Secondary analysis of postpartum women aged 15-49 years in 22 DHS surveys from 21 LMICs conducted between 2005 and 2012. We applied an adapted unmet need definition for postpartum women to look at prospective fertility preferences. We also constructed a new composite pregnancy risk indicator for postpartum women who have been sexually active since their last birth. Results: In 9 of 22 surveys, 50% or more of nonfirst births occur at interpregnancy intervals that are too short. Overall prospective unmet need for family planning by postpartum women has not changed demonstrably since a 2001 analysis and is universally high: 61% of all postpartum women across the 21 countries have an unmet need for family planning. In 10 of 22 surveys, pregnancy risk rises steadily throughout the 2 years after birth. In the remaining 12 surveys, the risk of pregnancy peaks at 6-11 months after birth. Even when postpartum women are using family planning, they rely overwhelmingly on short-acting methods (51-96% in 21 of 22 surveys). Conclusion: Our approach of estimating pregnancy risk by postpartum timing confirms a high probability for pregnancies to be less than optimally spaced within 2 years of a prior birth and suggests that special consideration is needed to effectively reach this population with the right messages and services. Implications: Using recent, multicountry data for women within 2 years postpartum in LMICs, this paper updates existing estimates of high prospective unmet need for family planning and presents a new composite pregnancy risk analysis based on postpartum women's actual practices to demonstrate the magnitude of missed opportunities for programmatic intervention for the postpartum population.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…Furthermore, the study was challenged in the concurrent monitoring of immunization services, a challenge previously noted in several studies on family planning-immunization integration in Africa [10131426]. Steps should be taken in future research and programming to address these challenges.…”

Section: Discussionmentioning

confidence: 99%

“…Early studies done in Togo and Mali show that integrating family planning services during the first twelve months after delivery with routine child immunization care can potentially reduce unmet need for family planning [10121314]. However, assessment of integration has focused on health facilities, despite the reliance of many women in low-resource settings on community health workers.…”

Section: Introductionmentioning

confidence: 99%

Quasi-experimental Study of Systematic Screening for Family Planning Services among Postpartum Women Attending Village Health and Nutrition Days in Jharkhand, India

Balasubramaniam¹,

Kumar²,

Sethi³

et al. 2018

International Journal of Integrated Care

View full text Add to dashboard Cite

Background:Systematic screening helps increase family planning uptake through integration with other services, including immunization. Though successfully demonstrated at health facilities, this strategy has not been demonstrated in communities. This study assessed the effectiveness of systematic screening to increase postpartum family planning use during community health days in India without adversely affecting immunization services.Methods:The study was conducted during 180 individual Village Health and Nutrition Days in Jharkhand, India. All health workers were trained in postpartum family planning counseling. Intervention providers were also trained in systematic screening. 217 postpartum women aged 15–49 years participated in baseline and endline exit interviews and routine service statistics were analyzed from 2,485 facility visits at affiliated health centers.ResultsNo difference in family planning service use was found in the intervention group, but significantly fewer interviewed women reported receiving family planning services at endline in the comparison group (p = 0.014). Family planning acceptance at affiliated health centers increased significantly in intervention areas (p < 0.001) but not in comparison areas, while immunization service use increased in both groups (p = 0.002 intervention, p < 0.001 comparison).Conclusions:The use of the postpartum systematic screening tool appears to increase acceptance of family planning services when integrated with community-based services in Jharkhand.

show abstract

“…Most existing research measures facility-level integration as a binary and static state. Generally, studies classify a facility as 'integrated' if an intervention aiming to improve integration has been implemented in the facility (19,20,22). Such binary measurement presents a false dichotomy that does not allow for incremental change in the level of integration within a facility over time.…”

Section: Measuring Integrationmentioning

confidence: 99%

“…Despite its potential to improve service delivery and health outcomes, there is little research evaluating policies and programs that support integration (16,18,19). Some research reports that integration of family planning and immunization services in sub-Saharan Africa is feasible and may increase contraceptive prevalence without detriment to immunization rates (20)(21)(22) however, other recent studies show no signi cant increase in family planning use when women receive family planning information and referrals during immunization visits (23)(24)(25). Systematic reviews highlight the need for more robust evidence about the effects of integration on service delivery and health outcomes (18,26).…”

Section: Introductionmentioning

confidence: 99%

Determinants of Family Planning and Child Immunization Services Integration in Urban Areas of Nigeria: A Longitudinal Analysis

Sheahan

Speizer

Orgill‐Meyer

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Unmet need for contraception is high in the postpartum period. Research has identified the role that integration of family planning into child immunization services can have in addressing this need. However, evidence about the effects of family planning and immunization integration has been inconsistent and more evidence is required to determine whether and how to invest in integration. This study applies continuous facility-level family planning and child immunization integration index scores to: (1) determine whether facility-level integration changes over time, (2) assess the impact of the Nigerian Urban Reproductive Health Initiative (NURHI) - a program that aimed to increase modern contraceptive use - on integration, and (3) identify determinants of integration across facilities in urban areas of Nigeria. Methods: Longitudinal data from health facilities in six urban areas of Nigeria are available from 400 facilities at baseline and 385 facilities at endline. Difference-in-differences models are used to assess the impact of NURHI on Provider Integration and Facility Integration Index scores, and to identify facility-level determinants of integration. The two outcome measures, Provider and Facility Integration Index scores, measure attributes that support integrated service delivery. The independent variables are (1) time period (2) whether the facility received the NURHI intervention, and (3) facility-level characteristics. Results: Our results show that the Provider Integration Index scores increased significantly only among non-intervention facilities while Facility Integration Index scores did not increase significantly in either group. We find that NURHI did not have a significant effect on integration index scores. Results also pinpoint facility characteristics that influence integration, including public ownership and the proportion of providers who have received family planning training. Conclusion: Programs aiming to increase integration of family planning and immunization services should monitor and provide targeted support for the implementation of a well-defined integration strategy that considers the influence of facility characteristics and concurrent initiatives.

show abstract

Successful Proof of Concept of Family Planning and Immunization Integration in Liberia

Cited by 45 publications

References 9 publications

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

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

Quasi-experimental Study of Systematic Screening for Family Planning Services among Postpartum Women Attending Village Health and Nutrition Days in Jharkhand, India

Determinants of Family Planning and Child Immunization Services Integration in Urban Areas of Nigeria: A Longitudinal Analysis

Contact Info

Product

Resources

About