Issues in integration of SRH services

Introduction
Ghana has one of the highest maternal mortality ratios in the world. A recent national survey (GSS et al., 2009a) revealed that about 451 women per 100,000 live births die due to pregnancy, unsafe abortion, or complications of labor in Ghana.
In Ghana, most hospitals and clinics have a FP unit where clients are referred to for services. However clients presenting to health facilities for non-FP purposes are not routinely screened and counseled for FP need.
From May 2010 to March 2011, the Reducing Maternal Morbidity and Mortality (R3M) Program in collaboration with the Ghana Health Service (GHS) embarked pilot project to improve access to FP services by integrating into other services at the facility level. This culminated in a baseline survey and the roll out of interventions in some health facilities in the Eastern and Ashanti regions of Ghana.

 

Considerations around repositioning family planning emphasize the need to integrate FP counseling and services with maternal and child health services particularly postpartum and post-abortion care. This paper examines the effect of the exposure to FP counseling and services during antenatal care, delivery and postpartum care on the use of contraceptives in four cities of Uttar Pradesh. Using midterm data collected in 2012 as part a longitudinal study, this paper focuses on women who had delivered in last two years (n=975). Among these, 36 percent reported adopting modern contraceptive postpartum, while 21 percent adopted traditional. Further, data reveals that only a small proportion of women received FP information and services during ANC (18%), delivery (22%) and PNC (13%), though large proportion had come in contact with providers. Multivariate analysis shows that women who delivered at facility and received counseling/services at that time are more likely to use contraceptive post-partum, than those who delivered either at home or did not receive any information in the facility. Clearly, the opportunity to reach potential FP clients with information and services during antenatal and delivery care services is largely missed, which needs to be strengthened to improve use of modern contraceptive methods.

Access to benefits from inclusive development programmes, maternal-child health (MCH) care and family planning (FP) services can aid development of country’s health. Early efforts to combine these services are still untested and approved. Structural equation models utilize to examine the effect of inclusive development programme at village level on the relationship between MCH and FP service utilization. A cross-sectional District Level Household Survey (2007-08) covered 76,147 currently married women age 15-44 years through multi-stage stratified probability proportion to size sampling. It was found there were no specific pattern of common exogenous predictors except children ever born (p<0.05), mothers education (p<0.05) and wealth index of households (p<0.05) for the service utilization. Finding suggests that FP, MCH care services and inclusive development programs are introduce and available, the likelihood of adoption of services is higher, compared only one service is available in state. The rationale for integration of family planning and MCH care services with inclusive development programme at village level have been based on three grounds: improving the efficiency and effectiveness of programmes and services; meeting clients need from “one-stop” service; and accelerating the pace of health and demographic outcomes.

Background: Men's support is key in improving the uptake of their partners’ sexual and reproductive health (SRH) services, hence contributing to efforts aimed at achieving Millennium Development Goals 4, 5 and 6. The study’s objective was to explore men’s perceptions on and uptake of SRH services in Kenya.
Methods: Data were derived from qualitative interviews conducted with 60 men from communities neighboring facilities that were part of a larger study that assessed the relative benefits of different models of integrated SRH/HIV service provision over separately provided services. Interviews were recorded, transcribed verbatim, translated and analyzed thematically.
Findings: Generally, men felt comfortable seeking SRH services together with their partners. Most services sought together were HIV counseling/ testing and family planning services. Other services, but minimally were HIV care/treatment, antenatal, postnatal, sexually transmitted infections screening/treatment, and condoms provision. Waiting times and service scheduling at facility were some of the barriers that hindered men’s uptake of services.
Conclusions: Study demonstrates that men are receptive to seeking services together with their partners. However, existing barriers need to be addressed in order to increase men’s uptake of SRH services.