Promising High-Impact Practice
Offering family planning information and services proactively to women in the extended postpartum period during routine child immunization contacts. The extended postpartum period is defined as the 12 months following a birth.
What Is It?
Immunization services offer an important opportunity to reach underserved women in the extended postpartum period. Immunization is one of the most widely used health services globally as shown by high vaccination coverage, with approximately one billion children vaccinated over the past decade (WHO 2022). There are multiple touch points through the repeated visits needed to follow the recommended vaccination schedule during the first year of an infant’s life. Integration offers benefits such as mitigating constraints related to transportation costs and time while also reducing the burden on the overall health system and, potentially, on individual workloads.
What Are the Benefits?
- Immunization services are a cornerstone of the primary health care system, reaching more people than any other health service globally. As a result, it is an ideal opportunity to reach large numbers of postpartum women with family planning.
- Child immunization services involve multiple timely contacts with mothers during the first year postpartum, increasing the number of opportunities to counsel on family planning and follow-up with new acceptors as to how it is going.
- Perceived benefits associated with family planning and immunization integration among providers and clients, including time-savings for both groups, perceptions of improved health among women and young children, and improved referrals of clients between the two services.
How to Implement?
Provide a Simple Job Aid to Help Providers Counsel and Identify Family Planning Needs
Working with health management teams, engage providers working in ANC, Child Welfare (immunization, sick/well baby clinic), postnatal, and other service areas to identify and manage the family planning needs of women of reproductive age. This can be done by implementing Francophone West Africa’s three-question ISBC (universal referral) job aid.
Build the Capacity of Service Providers
Technical service providers are expected to carry out family planning integration as per the national guidelines. Consider offering regular training and skills updates to help increase competence and confidence of the providers in delivering quality services.
This may include:
- Training district management teams and health facility managers using the ISBC trainer’s guide and provider manual to serve as trainers. The training includes coordination of the activity; (ii) training on the ISBC/FP approach; (iii) data recording; (iv) post-training follow-up; (v) supervision; and (vi) the process of institutionalizing the approach.
- Orienting other cadres using the whole-site orientation package. Introduce Provider Initiated Family Planning (PIFP) to both clinical and non-clinical staff. This process is recommended to assist both the health provider and clients identify unmet needs for family planning.
Ensure Availability of Integrated Services
Depending on the facility, determine the level of integration: Providing counseling and a referral, offering FP services in the same service unit, or referring the client to another service unit within the health center or to another health center if the identified need cannot be met during the current visit.
Equip the integration service areas with relevant equipment, stationary, IEC/job aids, FP commodities/supplies, referral tools and reporting tools based on the level of integration.
Ensure Documentation of All Services Provided
Make sure to document all services provided (e.g. information, counseling, referral, and FP method) at the integration service area. Use existing tools such as FP registers. Consolidate and report the data from the integration area using existing reporting channels.
For example, in Francophone West Africa, clients who decide to obtain a FP method should be recorded in the FP register. It should be recorded in red in the “Observations” column if the FP client was identified by the ISBC technique, with the annotation SAD (Additional Service) followed by the acronym of the service from which the client was referred (e.g., ANC, EPI or PAC).
What Is the Evidence?
- The Monitoring, Learning & Evaluation (MLE) Project for the Urban Reproductive Health Initiative conducted a study of the ISBC or universal referral approach in Senegal in 2014. It found that out of a total of 4,500 women of reproductive age who became family planning acceptors, 1,982 were recruited through the ISBC approach or universal referral approach. This translates to 44% of new acceptors coming from the ISBC approach.
- In Liberia, co-located provision of same-day, facility-based services were provided. Vaccinators were trained to provide family planning messages using job aids and same-day family planning referrals to mothers bringing their infants to the facility for routine immunizations. As a result, there was an increase in new contraceptive users among women referred from immunization services to same day, co-located family planning clinic. And there was an increase in the number of Penta1 and Penta3 doses administered across pilot sites compared with the same period of the previous year in sites in Lofa (Cooper et al. 2015).
- In Nepal, for women bringing children to immunization services, group education about healthy timing of pregnancies followed by an immunization provider giving further family planning counseling to women who indicated they wish to use contraception was provided. Internal referrals were provided for methods available at clinic (short acting) or external referral to methods not available on-site (long acting). This resulted in an increase in family planning uptake among hard-to-reach populations via integration with immunization service and had no effect on routine utilization of immunization services (Phillipson, 2013)
