Assessing the adoption and diffusion of family planning integration into postabortion and postpartum care in Togo, West Africa Public
Baker, Helen Frances (2017)
Published
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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