Abstract
Background: Family planning is a cost-effective
intervention. Integrating family planning into postabortion and
postpartum care increases contraceptive uptake, thereby reducing
maternal and child morbidity and mortality.
Purpose: This mixed methods case study sought to understand
the integration of family planning into postabortion and postpartum
care in Togo. It examined factors associated with modern
contraceptive use for women up to 24 months postpartum, monitoring
and evaluation of integrated family planning services, and barriers
and facilitators to access to and use of postabortion and
postpartum family planning.
Methods: The study included an analysis of the 2013/14 Togo
Demographic and Health Survey (DHS) of 2749 women who gave birth
within 24 months of the survey, 41 key informant interviews, 25
health facility assessments, a review of health service record
formatting, and participant observation.
Results: The DHS analysis found factors significantly
associated with postpartum contraceptive use included: health
facility birth, having a postnatal check-up, the youngest child's
receiving the first DPT vaccination, desiring to space births,
husband's agreeing on desired number of children, longer
breastfeeding duration, and living outside of the Savanes region.
Monitoring and evaluation of integrated health services was
limited. The reproductive, sexual, and child health monitoring
system included multiple steps of data entry, idiosyncratic systems
of recording integrated health services, and limited use of
technology. Barriers to provision and use of postabortion and
postpartum family planning included a lack of training for health
care workers, lack of necessary equipment, high levels of mistrust
related to family planning methods, and limited understanding of
the health benefits of spacing pregnancies. Facilitators of
integrated family planning included more health care worker
training, providing more family planning education to the
population, and ensuring all necessary equipment and supplies were
available and functional.
Conclusions: This study highlights the potential for integrated
health services in Togo. Programming and research should focus on
developing interventions for offering contraception during
immunization, intrapartum, and postpartum care; health care worker
training related to providing integrated family planning services;
community education about the benefits of birth spacing; and
developing systems to record integrated health services without
increasing health care providers' workload.
Table of Contents
Chapter 1: Introduction
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1
Figure 1.1
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3
Chapter 2: Factors associated with postpartum family planning
use in Togo ......................................... 24
Table 2.1
....................................................................................................................................
33
Table 2.2
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34
Table 2.3
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35
Table 2.4
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36
Table 2.5
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37
Figure 2.1
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39
Chapter 3: ‘It is a question of determination': a case
study of monitoring and evaluation of integrated family planning
services in Togo
..........................................................................................................................................
63
Table 3.1
....................................................................................................................................
77
Figure 3.1
...................................................................................................................................
79
Figure 3.2
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80
Figure 3.3
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81
Table 3.2
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83
Figure 3.5:
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84
Table 3.3
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85
Chapter 4: Barriers and facilitators of family planning
integrated into postabortion and postpartum care in urban areas of
Togo
................................................................................................................................................
113
Table 4.1
..................................................................................................................................
117
Figure 4.1
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125
Figure 3.2
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126
Table 4.2
..................................................................................................................................
127
Figure 4.3
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127
Table 4.3:
.................................................................................................................................
129
Table 4.4
..................................................................................................................................
130
Figure 4.4
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131
Figure 4.5
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132
Figure 4.6
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133
Table 4.5
..................................................................................................................................
134
Table 4.6
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135
Table 4.7
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137
Figure 4.7
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138
Table 4.8
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139
Figure 4.8
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141
Table 4.9
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142
Chapter 5: Summary and Conclusions
..........................................................................................
164
Table 5.1
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172
About this Dissertation
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