FACT SHEET A RATIONALE FOR INTEGRATING MATERNAL, NEWBORN AND CHILD HEALTH AND FAMILY PLANNING SERVICES Maternal, newborn and child health and the ability to control one’s fertility are important goals for families and key indicators of good health. To meet these goals, women need access to health services before, during and after birth, including access to family planning to limit or space pregnancies. Children need access to health care immediately after birth and throughout their first years of life to provide a foundation for healthy growth and development. Providing an integrated approach to continuous health care for mothers, newborns, and children can improve maternal, newborn and child health, and fulfilling the unmet need for family planning. Continuum of Care: A Model for Integration The continuum of care is a popular model that links maternal, newborn and child health services across time (adolescence and pre-pregnancy, pregnancy, birth, postpartum, newborn, infancy and childhood) and place (primary and secondary health facilities, communities and households). Integrating services across the continuum of care can reduce the risk of interruptions in care, increase the cost-effectiveness of interventions, and increase the convenience of care by eliminating visits to multiple health facilities and health providers.1-4 The Continuum of Care Across Time Adolescence and Pre-pregnancy
Pregnancy
Birth
Postpartum and Newborn
Infancy
Childhood
Outreach Services
Linking Places of Caregiving
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The Continuum of Care Across Space Health Facilities Communities Households
Making an Argument for Integration: Biology, Logistics and Cost Biology: The health of mothers, newborns, and children are interdependent. Pre-pregnancy problems for the mother, such as malnutrition or hypertension, may result in intrauterine growth restriction, preterm birth, low birth weight, or other complications for the newborn. This, in turn, may have short- and long-term consequences for the newborn later in childhood, such as cognitive and physical disabilities. Also, certain infectious diseases can be transmitted from mother to newborn, which can lead to increased mortality and morbidity.4, 5 Lack of access to family planning contributes to unintended pregnancies, which may result in maternal death or disability. Logistics: One of the major benefits of integrating maternal, newborn and child health and family planning services is the alleviation of distance and cost-related obstacles to access. Many services that mothers and children require can be provided by the same caregiver and/or at the same point of service delivery. This may reduce both the number of visits and the associated fees with accessing services. Integrating health care services also provides women and children with more opportunities to enter the health care system for services and referrals.6-8 Cost: By eliminating duplicate administrative functions and using common infrastructure and processes, integrating services can increase efficiency while delivering a broad range of services.9-11 Integrated health programs would also help to effectively use already limited human and financial resources allocated to health systems.12, 13 Providing information or services at various points in the continuum may also reduce poor health outcomes, and related future expenses.
Example of the Integration: Immediate Insertion of an Interuterine Device The IUD is the second most popular method of family planning worldwide, with nearly 160 million users, and offers a nonhormonal, nonpermanent form of family planning to space or prevent subsequent pregnancies.14-16 IUDs require fewer visits to a health center compared to some hormonal methods, thus requiring less expenditure of time, money and effort.16 One of the most efficient times to insert an IUD is after delivery, particularly for women with limited access to healthcare.17 The presence of a skilled health provider trained in IUD insertion allows women to receive counseling on this and other contraceptive methods, and to request IUD insertion. »
A study in Peru found that providing women with the option of postpartum IUD insertion not only increased IUD uptake but also increased women’s participation in postpartum obstetric care.18
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A study in Honduras found that providing women with the option of IUD insertion immediately after delivery was optimal because they were able to provide IUDs to women who would have not otherwise have considered IUD insertion and were able to ensure that a trained provider was available, which many not be assured if the woman had returned to the clinic at a later time.18
Challenges »
Integration may place additional burdens on already fragile health care systems. The integration of services may place a severe burden on health care workers that could acutually damage their performance.9
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Integrated programs face many of the same challenges that burden population-specific programs, including lack of funding and other resources, insufficient or inadequately trained staff, and poor supervision and management.9
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Integrating services is a challenging technical process the requires coordination of government, donors, program implementers, and health care workers. Transitions from population-specific to integrated programs require careful planning, including asssessments of the costs and resources needed to make the shift, and the new training, supervision, and management.11, 19
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More research is needed to identify the opportunities for integration and assess where this is an appropriate and useful strategy and where it is not. Integrated programs should be tailored to local populations, adding and ommitting different interventions as necessary to address the local burden of disease.12
AUGUST 2009
**An expanded version of this document can be found on our website http://www.globalhealth.org/publications/** References
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