Assessing the adoption and diffusion of family planning integration into postabortion and postpartum care in Togo, West Africa Open Access

Baker, Helen Frances (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/p2676w24d?locale=en
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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 .................................................................................................................. 1 Figure 1.1 ..................................................................................................................................... 3 Chapter 2: Factors associated with postpartum family planning use in Togo ......................................... 24 Table 2.1 .................................................................................................................................... 33 Table 2.2 .................................................................................................................................... 34 Table 2.3 .................................................................................................................................... 35 Table 2.4 .................................................................................................................................... 36 Table 2.5 .................................................................................................................................... 37 Figure 2.1 ................................................................................................................................... 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 ................................................................................................................................... 80 Figure 3.3 ................................................................................................................................... 81 Table 3.2 .................................................................................................................................... 83 Figure 3.5: ................................................................................................................................. 84 Table 3.3 .................................................................................................................................... 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 ................................................................................................................................. 125 Figure 3.2 ................................................................................................................................. 126 Table 4.2 .................................................................................................................................. 127 Figure 4.3 ................................................................................................................................. 127 Table 4.3: ................................................................................................................................. 129 Table 4.4 .................................................................................................................................. 130 Figure 4.4 ................................................................................................................................. 131 Figure 4.5 ................................................................................................................................. 132 Figure 4.6 ................................................................................................................................. 133 Table 4.5 .................................................................................................................................. 134 Table 4.6 .................................................................................................................................. 135 Table 4.7 .................................................................................................................................. 137 Figure 4.7 ................................................................................................................................. 138 Table 4.8 .................................................................................................................................. 139 Figure 4.8 ................................................................................................................................. 141 Table 4.9 .................................................................................................................................. 142 Chapter 5: Summary and Conclusions .......................................................................................... 164 Table 5.1 .................................................................................................................................. 172

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