Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Aug 24;20(1):777.
doi: 10.1186/s12913-020-05571-1.

Integrated delivery of family planning and childhood immunisation services in routine outreach clinics: findings from a realist evaluation in Malawi

Jessie K Hamon  1 , Shari Krishnaratne  2 , Jenna Hoyt  2 , Misozi Kambanje  3 , Shannon Pryor  4 , Jayne Webster  2
Affiliations

Integrated delivery of family planning and childhood immunisation services in routine outreach clinics: findings from a realist evaluation in Malawi

Jessie K Hamon et al. BMC Health Serv Res. .

Abstract

Background: Family planning (FP) needs among postpartum women in low- and middle-income countries remain largely unmet. Integrating FP with childhood immunisation services could partially reduce this unmet need by creating multiple opportunities for timely contact with FP services during the 12 months following childbirth.

Methods: A realist evaluation of an intervention integrating FP and childhood immunisation services in routine outreach clinics in two rural districts of Malawi was conducted. A Context-Mechanism-Outcome (CMO) framework was used to describe the drivers of the intervention. A detailed programme theory was developed based on the analysis of semi-structured interviews and focus group discussions with 50 stakeholders.

Results: A total of 9 core mechanisms were identified, which centred on constructs of access. Findings revealed that on the demand side, women were motivated to attend outreach clinics due to shorter travel distances; they felt confident they could access FP services and use contraceptive methods covertly if needed; and when supported by their husband, they were empowered to take up the use of contraceptive methods. On the supply side, providers were empowered through the training they received to provide integrated services; they were confident in their ability to provide essential services; and they were motivated by teamwork and by the recognition they received for their work. Additionally, some providers were found to be unwilling to walk long distances to reach remote clinics, which was seen to negatively affect the availability of services.

Conclusions: The delivery of integrated FP and childhood immunisation services in the context of routine outreach clinics in rural Malawi was seen to trigger mechanisms of accessibility and to improve the acceptability and availability of FP services. However, further research is needed to understand how the integration of these services in a routine outreach clinic setting may affect other dimensions of accessibility, including the approachability, appropriateness and affordability of services.

Keywords: Accessibility; Childhood immunisation; Family planning; Integration; Malawi; Outreach clinic; Realist evaluation.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Intervention model for integrated FP and childhood immunisation services
Fig. 2
Fig. 2
Initial programme theory
Fig. 3
Fig. 3
Access to Health Care framework [18] with mechanisms of accessibility
See this image and copyright information in PMC

References

    1. UN General Assembly. Transforming our world: the 2030 agenda for sustainable development. New York; 2015. Available from: www.un.org/en/development/desa/population/migration/generalassembly/docs.... [cited 2020 Jul 3].
    1. DaVanzo J, Hale L, Razzaque A, Rahman M. Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh. BJOG An Int J Obstet Gynaecol. 2007;114(9):1079–1087. doi: 10.1111/j.1471-0528.2007.01338.x. - DOI - PMC - PubMed
    1. Conde-Agudelo A, Rosas-Bermundez A, Kafury-Goeta A. Birth spacing and risk of adverse perinatal outcomes a meta-analysis. JAMA. 2006;295:1809–1823. doi: 10.1001/jama.295.15.1809. - DOI - PubMed
    1. Cleland J, Conde-Agudelo A, Peterson H, Ross J, Tsui A. Contraception and health. Lancet. 2012;380(12):149–56. Available from: 10.1016/S0140-6736(12)60609-6. - PubMed
    1. Ajong AB, Njotang PN, Yakum MN, Essi MJ, Essiben F, Eko FE, et al. Determinants of unmet need for family planning among women in urban Cameroon: a cross sectional survey in the Biyem-Assi Health District, Yaoundé. BMC Womens Health. 2016;16(1):1–8. Available from: 10.1186/s12905-016-0283-9. - PMC - PubMed