Framework for Action

Countries: Malawi, Liberia


Despite the fact that many postpartum women wish to prevent or delay future pregnancies, uptake of modern contraceptives remains low, resulting in calls to leverage additional touch points between postpartum women and health services to offer FP services. Immunization services provide an opening to reach postpartum women given that immunization is a widely accessed health services, requiring multiple visits during the extended postpartum period¹ ². Service delivery models include:

  • Combined service provision (co-located, same-day FP/immunization services).
  • Combined service provision plus referral for FP methods not available at the
  • Single service provision plus referral where co-located, same-day services are
    not feasible.

Added Value:

Contribution to FP: leveraged combined service provision plus same day referrals resulting in increase in FP uptake and use at facility and community service points³.

Contribution to RI: neutral - no negative impact on RI.

Contribution to FP: Combined service provision resulted in an increase in new contraceptive users referred from immunization services².

Contribution to RI: increase in the number of Penta1 and Penta3 doses administered in pilot sites in one region².

PHC levers:

Enabling factors: models of Care (integration of FP/immunization and potentially other PHC services); M&E (opportunity to track indicators for both immunization and FP; monitor impact on both); PHC oriented research (to ensure integration is context appropriate, formative research can inform design of integrated service delivery models).

Constraining factors: political commitment & leadership (concerns that there may be a negative impact on immunization services may reduce political will); governance & policy frameworks (lack of policies and guidelines to facilitate integration); PHC workforce (inadequate quantity of HCWs to support integration; challenges to supervision); engagement of communities & other stakeholders (lack of male engagement).

When to consider this approach:

  • In contexts with high immunization coverage rates (from fixed, facility-based services, this is less appropriate in programs dependent on mass vaccination campaigns).
  • While undertaking planned revisions to national strategies and operational policies and plans (e.g. national human resources for health policies, training guidelines, supply chain upgrades).