The Challenges of Integrating Family Planning and HIV Services: An Analysis of Programmer and Policymaker Opinions in Malawi, Nigeria, and Senegal

In sub-Saharan Africa, pregnancy and HIV are “transmitted” in primarily the same way: through unprotected, heterosexual sex. And in most African countries, there are more pregnancies than desired, and certainly too many new cases of HIV. These similarities, patterns of health care access, and differential availability of funding suggest that integrating family planning and HIV services should lead to better outcomes. But despite years of talk about the benefits to integration, it remains more rhetoric than reality. Why? To answer this question, I conducted interviews with more than 90 programmers working for federal ministries, donor organizations, and local nongovernmental organizations in Malawi, Nigeria, and Senegal. The opinions of these programmers are crucial to successful outcomes as it is they who will have to promote integration efforts to their ministers and funders as well as to those who actually implement health care. I show that the primary perceived obstacles to integration are the bureaucratic structure of donor organizations and government ministries, combined with overburdened primary health care providers. I find, however, that in Malawi and Senegal, programmers are trying to use the distinctions between pregnancy and HIV prevention to benefit those they serve.