The integration of family planning and childhood immunization services in Togo.

Quality of care is currently construed to mean matching population needs with service provision. Improvements in African services are valued when there is a constellation of multiple services provided in a fixed center. In Togo a simple intervention was developed to link childhood immunization and family planning services. Before immunizing each child the service provider would make 3 family planning statements to the childs mother. The statements were salient and easy to remember: "Madame your child is still young and you should be concerned about having another pregnancy too soon." "This clinic provides family planning services that can help you delay your next pregnancy." And "You should visit the family planning services after the immunization today for more information." Clinic staff were trained in a day and a half orientation session. The referral message was evaluated with a quasi-experimental design. Impact was measured in terms of knowledge of family planning methods and availability of family planning in the clinic intention to use a contraceptive method and the history of contraceptive use. 16 urban and rural clinics were involved. The sample included 1000 randomly selected women who has just had their children immunized. The pretest was conducted in January 1992 and the post test was conducted in August 1992 6 months after the intervention in the study. Service statistics were also collected from 9 months prior to the intervention until September 1992. Pretest and post test women were similar demographically. Recall levels were also similar. The results indicated that control group persons did not show any change in their awareness of family service availability in the clinic. The increase in the study group was from 40% to 58%. Differences between awareness in the control and study groups was 8% before the intervention and 22% after. Women desiring a longer birth-spacing period were more likely to be aware of service availability. The mean number of acceptors in the study group increased significantly from 200 to 307; average monthly number of family planning users also increased significantly from 1035 to 1311 which was a significant difference from control group users. Both groups showed significant increases in number of vaccines administered monthly in the study period.