Integrating family planning messages into immunization services: a cluster-randomized trial in Ghana and Zambia

Health Policy Plan. 2014 May;29(3):359-66. doi: 10.1093/heapol/czt022. Epub 2013 Apr 9.


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.

Trial registration: NCT00949481.

Keywords: Family planning; immunization; integration; referrals; vaccinators.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Ghana
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Immunization Programs / methods*
  • Immunization Programs / organization & administration
  • Infant
  • Postnatal Care / methods
  • Postnatal Care / organization & administration
  • Sex Education / methods*
  • Sex Education / organization & administration
  • Young Adult
  • Zambia

Associated data