Client and provider factors associated with integration of family planning services among maternal and reproductive health clients in Kigoma Region, Tanzania: a cross-sectional study, April–July 2016

Abstract

BackgroundIntegration of family planning (FP) services into non-FP care visits is an essential strategy for reducing maternal and neonatal mortality through reduction of short birth intervals and unplanned pregnancies.MethodsCross-sectional surveys were conducted across 61 facilities in Kigoma Region, Tanzania, April–July 2016. Multilevel, mixed effects logistic regression analyses were conducted on matched data from providers (n = 330) and clients seeking delivery (n = 935), well-baby (n = 272), pregnancy loss (PL; n = 229), and other routine (postnatal, HIV/STI, other; n = 69) services. Outcomes of interest included receipt of FP information and a modern FP method (significance level p < 0.05).ResultsClients had significantly greater odds of receiving FP information if the primary reason for seeking care was for PL versus (vs) any other types of care (aOR 1.97), had four or more pregnancies vs fewer (aOR 1.78), and had had a FP discussion with their partner vs no FP discussion (aOR 1.73). Clients had lower odds of receiving FP information if they were aged 40–49 vs 15–19 (aOR 0.50) and reported attending religious services at least weekly vs less frequently (aOR 0.61). Clients of providers who perceived that in-service training had helped vs had not helped job performance (aOR 2.27), and clients of providers having high vs low recent FP training index scores (aOR 1.58) had greater odds of receiving FP information.Clients had greater odds of receiving a modern method when they received information on two or more vs fewer methods (aOR 7.13), had had a FP discussion with their partner vs no discussion (aOR 5.87), if the primary reason for seeking care was for PL vs any other types of care (aOR 4.08), had zero vs one or more live births (aOR 3.92), made their own FP decisions vs not made own FP decisions (aOR 3.17), received FP information from two or more vs fewer sources (aOR 3.12), and were in the middle or high vs the low wealth tercile (aOR 1.99 and 2.30, respectively). Well-baby care clients, Other routine services clients, and married clients had significantly lower odds of receiving a method (aOR 0.14; aOR 0.08; and aOR 0.41, respectively) compared to their counterparts.ConclusionsStrategies that better integrate FP into routine care visits, encourage women to have FP discussions with their partners and providers, increase FP training among providers, and expand FP options and sources of information may help reduce the unmet need for FP, and ultimately lower maternal and neonatal mortality.

Family planning uptake in Kagera and Mara regions in Tanzania: a cross-sectional community survey

“…Women who reported discussing family planning issues with their male partners were more likely to use family planning methods. Similar results were reported in India (35), Bangladesh (36) and Tanzania (23,37). Involvement of male partners in reproductive health provides an opportunity for couples to discuss family issues and decisions to use family planning (38).…”

How gender and religion impact uptake of family planning: results from a qualitative study in Northwestern Tanzania

“…Family planning information is not uniformly provided to patients seeking healthcare in Tanzania. A recently published cross-sectional study shows that women are less likely to receive family planning information if they have not discussed this topic with their partner [5]. Other studies show that joint decision making about family planning is rare; men are considered primary decision makers regarding household matters, including number of children, and spacing of births [6].…”

“…In the absence of spousal support and lack of information, Tanzanian women have low utilization of family planning methods. Less than 10% of women who sought healthcare over four-month period in rural western Tanzania reported utilizing a family planning method [5]. Further, data demonstrate that women who regularly attend religious services are unlikely to receive family planning information at their health visits [5].…”

Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

“…We examined the internal coherence of the indexes by comparing facility characteristics and index scores across low, medium, and high integration groups (41). We note signi cant differences in facility characteristics and overall index scores across all groups for both indexes, indicating that both indexes have strong internal coherence (see p-values in Table 4).…”

“…Integration Index scores changed when different sub-sets of variables were entered into the PCA (41). To assess the robustness of the Provider Integration Index, we ran 6 variations of the PCA.…”