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Integrating Family Planning and Immunization Services in Benin: Adding to the Evidence of a Promising Practice good

Heidi Schroffel & Jimmy Nzau - CARE USA, Marius Gnintoungbe - CARE Benin/Togo


BACKGROUND With a modern contraceptive prevalence rate of 8%, Benin has one of the lowest levels of family planning (FP) use in the world. Efforts to increase uptake of FP services include a focus on women in the extended post-partum period, who are particularly vulnerable to unplanned and high-risk pregnancies, while experiencing more frequent contact with the health system, opening up opportunities for intervention. Effective integration of FP and routine immunization services has shown the potential to strengthen the delivery and utilization of both FP and immunization services, but more evidence is needed to fully understand the impact of the integration approach and the effects of different implementation models. CARE Benin/Togo’s HIN NOU VIVO! (“Wellbeing of the Family”) project started integrating FP and immunization services in 20 public health facilities in the southeast of Benin in January 2016. The preliminary results presented here aim at contributing to the scarce existing body of knowledge on FP/Immunization integration approaches.


The Integration Model Women take their children to the health facility for routine immunizations.

While they wait, women receive group education on FP.

GOAL & OBJECTIVE The overall goal of the HIN NOU VIVO! project is to reduce maternal and child morbidity and mortality by preventing unwanted pregnancies - particularly in the extended post-partum period - and increasing routine immunization coverage for children in the first two years of life. The objective is to increase the uptake of FP and immunization services in 20 health facilities using an integration approach that reduces missed opportunities for both interventions.

The vaccinator provides FP referrals.

Women receive FP service and are reminded of their child’s next immunization appointment.

The HIN NOU VIVO! project’s integration model has proven feasible in the project area in southeast Benin. We observed a marked increase in new FP users overall after the first six months of the project (mainly dedicated to project launch and training activities), without negatively impacting immunization services. At the same time, project sites experienced a strong increase in the proportion of new FP users who stated immunization services as their referral source. Since the majority of women attending childhood immunization services are women in the extended post-partum period, it appears that the integration model reaches this vulnerable population - which often experiences particularly high levels of unmet need for contraception - with FP messaging and services to a larger extent that FP provision alone. While these initial results are encouraging, to date it has been difficult to monitor the accuracy of referral tracking, which appears to be underreporting referrals to FP services. In addition, operational fidelity to the integration model needs to be assessed further.


METHODS A one-year formative pilot project in 2015 explored the opportunities for FP/Immunization integration and developed context-specific integration processes and tools in seven health facilities in the Ouemé department in southeast Benin. As of 2016, the HIN NOU VIVO! project has been implementing FP/Immunization integration in 20 public health facilities in collaboration with local health authorities. The project implements a combined service provision model, referring women to co-located, sameday FP visits during their children’s routine immunization visits. The approach consists of group sessions with educational messaging, followed by systematic, standardized, individual referrals using a set of educational materials and field-tested job aids. Indepth training on FP service provision, the integration process and stock management strengthen the supply side while community engagement activities are aimed at increasing demand and support for services among the target community. The data presented here show the integration approach that was developed and service delivery data from routine monitoring activities.

FP / Immunization integration is feasible in the project area, using a timeintensive participatory process that actively involves stakeholders - with potentially competing priorities - at all levels.

The developed integration model is resulting in increased FP uptake and a greater proportion of referrals from immunizations among new FP users without negatively impacting immunization services.

Further research is needed to assess fidelity of the integration model on the ground as well as the contribution of different project elements to the results.

Project Launch & Training Activities

Acknowledgements The authors want to thank the Pfizer Foundation for their generous funding and the government of the Republic of Benin and local stakeholders for their collaboration and support of the HIN NOU VIVO! project as well as Claudia Moya and Dora Curry from CARE USA for their contributions to this poster.

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