Academic journal article International Perspectives on Sexual and Reproductive Health

The Integration of Family Planning with Other Health Services: A Literature Review

Academic journal article International Perspectives on Sexual and Reproductive Health

The Integration of Family Planning with Other Health Services: A Literature Review

Article excerpt

CONTEXT: Integrating family planning services with other health services may be an effective way to reduce unmet need. However, greater understanding of the evidence on integration is needed.

METHODS: Studies that evaluated the integration of family planning with any other type of health service were identified by searching five databases. To be included, studies had to have: been published in English between 1994 and 2009; used either a single-group pre- and posttest design or a two-group control or comparison design; and reported a family planning-related behavioral or reproductive health outcome.

RESULTS: Nine studies met the inclusion criteria. The integration interventions ranged from simple referrals between providers of existing services to fully integrated, community-based delivery of education and services. One evaluation used a quasi-experimental design; two used case-control comparison designs; two used combination designs; and the rest used either a single-group pre- and posttest design or a two-group cross-sectional design. Seven studies found improvements in family planning-related outcomes, although not all reported the significance of these changes; another reported mixed results and one found no effect. Of the studies that examined providers', clients' or community members' perspectives of integration, all reported overall satisfaction. No studies provided an economic analysis.

CONCLUSIONS: The evidence supporting the integration of family planning with other health services remains weak, and well-designed evaluation research is still needed. Future research should report outcomes for all health areas being integrated and should investigate in more detail the perspectives of providers, clients and community members and assess the cost-effectiveness of integration.

International Perspectives on Sexual and Reproductive Health, 2010, 36(4): 189-196

Despite decades of progress in improving the delivery and availability of family planning services, high levels of unmet need for family planning still exist in many countries. (1) This suggests that novel approaches are needed to extend access to family planning services to women and couples who desire to limit or space their childbearing but are not currently using contraceptives. The integration of family planning with other health services may be one such approach. Although integration may seem logical, the results of efforts to integrate child (2) or primary (3) health care services with other services suggest that integration presents many logistic challenges and that caution is advisable. Shelton and Fuchs warn that the fragility of health systems in many countries can constrain effective integration of services. (4) Therefore, an evidence base demonstrating the effectiveness of integration needs to be established before substantial investments are made in promoting integration as a means of fulfilling unmet need for family planning.

Numerous studies have examined the integration of family planning with programs for HIV/AIDS or other STIs. (5-9) Other studies have explored integration of health services (in some cases family planning services) with childhood immunization programs (10) or intimate partner violence programs. (11) Another study reviewed the integration of primary health care services in general. (3) To our knowledge, however, no comprehensive review has been conducted examining integration of family planning services with any type of health service. Therefore, we reviewed the literature to understand the current state of knowledge about the effectiveness of such integration.

METHODS

We searched the peer-reviewed literature to identify quantitative studies conducted anywhere in the world that evaluated the integration of family planning services with any other type of health service. We established, a priori, two inclusion criteria for the studies in this review. First, the study had to report a family planning-related behavioral or reproductive health outcome, such as contraceptive prevalence or service utilization. …

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