Integration of Family Planning and Child Immunization Services: Its Determinants and Effects on Service Delivery and Postpartum Contraceptive Use in Health Facilities in Urban Areas of Nigeria

Public Deposited
Analytics

Downloadable Content

Download PDF
Request Version for Screen Reader
Last Modified
  • March 22, 2019
Creator
  • Sheahan, Kate
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Integration of family planning into child immunization services has been lauded for its potential to decrease unmet need for postpartum contraception by offering family planning information and services to women during routine child immunization visits. Yet evidence about the effects of integration is scant and conflicting. This study develops and applies integration indexes to identify determinants and effects of integration in urban areas of Nigeria. First, we develop a Provider Integration Index and a Physical Integration Index and then generate integration index scores for 400 health facilities. Our results show considerable variation in the level of integration. This suggests that although some facilities have achieved high levels of integration, many others have limited capacity to provide integrated services. Second, we employ the indexes to 1) determine whether facility-level integration changes over time, 2) assess the impact of Nigerian Urban Reproductive Health Initiative (NURHI) on facility-level integration, and 3) identify determinants of integration. Our results show that: 1) Provider Integration Index scores increased significantly only among comparison group facilities and the increase in Physical Integration Index scores was not statistically significant in the intervention or comparison group; 2) The NURHI intervention did not significantly affect Provider and Physical Integration Index scores; and 3) Several facility-level characteristics are determinants of Provider and Physical Integration Index scores. These results inform understanding of factors associated with the extent of integration attained within a facility, which is essential to the development of sustainable and scalable integration initiatives. Third, we apply the integration indexes to measure the association between integration and 1) client-reported receipt of family planning information during an immunization visit, 2) correct identification of family planning service availability, and 3) postpartum use of any method to prevent pregnancy. We found that Provider and Physical Integration Index scores are not significantly associated with postpartum contraceptive use. Our results also show that Physical Integration Index scores are negatively associated with receipt of family planning information and that Provider Integration Index scores are positively associated with correct identification of family planning service availability. These results challenge the position that integration improves service delivery and contraceptive use.
Date of publication
Keyword
DOI
Resource type
Advisor
  • Paul, John
  • Weinberger, Morris
  • Bennett, Antonia
  • Curtis, Sian
  • Speizer, Ilene
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
Language

Relations

Parents:

This work has no parents.

Items

Thumbnail Title Date Uploaded Visibility Actions
file details Sheahan_unc_0153D_17593.pdf 2019-04-12 Public Download
file details PREMIS_Events_Metadata_0_e90e9ef3-81c6-4459-bf36-f17b77f24c93.txt 2019-04-12 Public Download
file details original_metadata_file_e90e9ef3-81c6-4459-bf36-f17b77f24c93.xml 2019-04-12 Public Download