Abstract
Background: Most postpartum women in low- and middle-income countries want to delay or avoid future pregnancies but are not using modern contraception. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. However, there is limited evidence on effective service integration strategies. We examine facilitators of and barriers to effective PPFP integration in MNCH services in Kenya and India. Methods: We conducted a cross-sectional, mixed-method study in two counties in Kenya and two states in India. Data collection included surveying 215 MNCH clients and surveying or interviewing 82 health care providers and managers in 15 health facilities across the four sites. We analyzed data from each country separately. First, we analyzed quantitative data to assess the extent to which PPFP was integrated within MNCH services at each facility. Then we analyzed qualitative data and synthesized findings from both data sources to identify characteristics of well and poorly integrated facilities. Results: PPFP integration success varied by service delivery area, health facility, and country. Issues influencing the extent of integration included availability of physical space for PPFP services, health workforce composition and capacity, family planning commodities availability, duration and nature of support provided. Conclusions: Although integration level varied between health facilities, factors enabling and hindering PPFP integration were similar in India and Kenya. Better measures are needed to verify whether services are integrated as prescribed by national policies.
Highlights
In low- and middle-income countries, nearly one-fifth of birth intervals are less than 24 months, increasing health risks for both mothers and children[1,2,3]
This paper presents findings from one component of a descriptive evaluation of postpartum family planning (PPFP) service integration conducted in India (May–June 2014) and Kenya (June-July 2014)
PPFP integration programs began in five states in India in 2010 and provided support for introducing PPFP counseling during antenatal care (ANC) and reorganizing intrapartum and immediate postpartum care to offer postpartum intrauterine device (PPIUD) services immediately after birth
Summary
In low- and middle-income countries, nearly one-fifth of birth intervals are less than 24 months, increasing health risks for both mothers and children[1,2,3]. The integration of PPFP from pregnancy to the extended postpartum period (of two years following childbirth) is seen as a promising strategy for increasing the availability and utilization of PPFP services[5,6,7]. Integration, in this context, means the deliberate joining together of “inputs, organization and delivery of particular functions” to increase efficiency and access to health services[8]. One promising strategy for increasing the use of postpartum family planning (PPFP) is integration with maternal, newborn and child health (MNCH) services. Better measures are needed to verify whether services are integrated as prescribed by national policies
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