Integrated Family Planning and Routine Child Immunization Services in Benin: A Process Evaluation.

INTRODUCTION: Integration of routine infant immunization and family planning services (FP/EPI) seeks to create opportunities for increased uptake of postpartum contraception. This evaluation assessed the implementation of a combined service provision model and experiences of postpartum women seeking services at integrated FP/EPI facilities in Benin.
METHODS: We used a mixed qualitative methods design to conduct a process evaluation of services at eight facilities supported by CARE's HIN NOU VIVO! PROJECT: We facilitated focus group discussions with 56 postpartum women who attended integrated sessions, divided into family planning users and non-users. Using grounded theory methodology, we explored women's experiences with the integrated services. We conducted 159 patient flow analyses and evaluated fidelity to the integration model.
RESULTS: Focus group participants responded positively to FP group education sessions during integrated FP/EPI days, but found the referral process confusing. Contraceptive use was motivated mainly by a desire for birth spacing, whereas fear of side effects and lack of spousal engagement were cited as reasons for contraceptive non-use. In four out of eight facilities, staffing shortages prevented FP group education sessions and referrals. DISCUSSION: Integrated FP/EPI services are feasible and accepted by postpartum women, but require consistent implementation across facilities. To achieve service integration goals, projects need to ensure availability of trained staff, supportive supervision, clear referral processes, and activities addressing the role of spouses and other stakeholders in reproductive health decisions.