Perceptions of quality and the integrated delivery of family planning with childhood immunisation services in Kenya and Uganda

PLoS One. 2022 Jun 6;17(6):e0269690. doi: 10.1371/journal.pone.0269690. eCollection 2022.

Abstract

The integration of family planning (FP) with childhood immunisations is considered a promising approach to addressing postpartum women's unmet need for FP in resource limited settings. This study set out to examine client and health provider perceptions of the quality of FP services that were integrated with childhood immunisations in Kenya and Uganda. Semi-structured interviews with clients (n = 30) and health providers (n = 27) were conducted in 16 rural health facilities. Interviews centred on the respondents' experiences receiving/delivering FP services, their interactions with providers/clients, and their views on the quality of FP services. Client and provider perceptions of quality were compared through a thematic analysis of interview transcripts, and findings were synthesised using Jain and Hardee's revised FP Quality of Care Framework. Using audit data, health facility characteristics and resources were also summarised through descriptive statistics to contextualise the qualitative findings. The dignity and respect experienced by clients was central to the respondents' perceptions of quality. These two dimensions were not conceptualised as distinct facets of quality, but were instead perceived to be a product of the 1) access to needed services, 2) choice of contraceptives, 3) interpersonal communication, 4) information, and 5) confidentiality afforded to clients. Additionally, clients and providers alike believed that the integration of FP services with childhood immunisations had a positive effect on clients' access to needed services and on the confidentiality they experienced in a context where modern contraceptive use was stigmatised and where a lack of support from some husbands impeded access to FP services. Understanding clients' and providers' conceptualisation of quality is critical to the design of high quality and client-centred integrated FP services.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Contraceptive Agents*
  • Family Planning Services* / methods
  • Female
  • Humans
  • Immunization
  • Kenya
  • Uganda

Substances

  • Contraceptive Agents

Grants and funding

This study was funded by an award from the Pfizer Foundation received by JW. The Pfizer Foundation is a charitable organisation established by Pfizer Inc. and is a separate legal entity from Pfizer Inc. with distinct legal restrictions. The Foundation had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. https://www.pfizer.com/about/responsibility/global-impact/the-pfizer-foundation.