Health Policy and Planning
Volume 29 Issue 3 May 2014
http://heapol.oxfordjournals.org/content/current

Integrating family planning messages into immunization services: a cluster-randomized trial in Ghana and Zambia
Gwyneth Vance1,*, Barbara Janowitz1, Mario Chen1, Brooke Boyer1, Prisca Kasonde1, Gloria Asare2, Beatrice Kafulubiti3 and John Stanback1
Author Affiliations
1FHI 360 – Program Sciences, Durham, NC, USA, 2Ghana Health Service, Accra, Ghana and 3Zambia Ministry of Health, Kabwe, Zambia
Accepted March 15, 2013.
Abstract
Objective To determine whether integrating family planning (FP) messages and referrals into facility-based, child immunization services increase contraceptive uptake in the 9- to 12-month post-partum period.
Methods A cluster-randomized trial was used to test an intervention where vaccinators were trained to provide individualized FP messages and referrals to women presenting their child for immunization services. In each of 2 countries, Ghana and Zambia, 10 public sector health facilities were randomized to control or intervention groups. Shortly after the introduction of the intervention, exit interviews were conducted with women 9–12 months postpartum to assess contraceptive use and related factors before and after the introduction of the intervention. In total, there were 8892 participants (Control Group Ghana, 1634; Intervention Group Ghana, 1129; Control Group Zambia, 3751; Intervention Group Zambia, 2468). Intervention effects were evaluated using logistic mixed models that accounted for clustering in data. In addition, in-depth interviews were conducted with vaccinators, and a process assessment was completed mid-way through the implementation of the intervention.
Results In both countries, there was no significant effect on non-condom FP method use (Zambia, P = 0.56 and Ghana, P = 0.86). Reported referrals to FP services did not improve nor did women’s knowledge of factors related to return of fecundity. Some providers reported having made modifications to the intervention; they generally provided FP information in group talks and not individually as they had been trained to do.
Conclusion Rigorous evidence of the success of integrated immunization services in resource poor settings remains weak.