Assessment of integration of post-partum and post-abortion family planning with Reproductive, Maternal, Neonatal, Child, Adolescent health and Nutrition services in selected primary health care facilities in Somali Region, Ethiopia. A Qualitative study
Authors: Warsame Muktar Shekabdulahi , Mohamued Elyas Abdulahi , Nuru Muhammed Abedella , Estifanos Abiy Seifu , Endris Bilal Shikur , Mohammed Jemal Kassaw , Kebede Addisalem Titiyos , Ali Kawsar Hussein , Roble Abdurahman Kedir , Aden Mowlid Akil , Guled Rashid Abdi 
Published: February 2024

Abstract
Background: Unintended pregnancies commonly occur in low and middle-income countries during the twelve months of post-partum. The World health organization recommends an interval of 24 months or more to reduce adverse outcomes for the mother and the child. But most women, especially in the postpartum period, have little or no understanding of fertility. Ethiopia’s mini demographic and health survey in 2019 showed only 41% of married women use modern contraceptives. In the Somali region, modern contraceptive use is reported as low as 3%. There is limited evidence on the effectiveness of post-partum and post-abortion family planning integration with reproductive, maternal, neonatal, child, and adolescent health and nutrition services (RMNCAN) to guide program efforts and policy action on health services. Therefore, this study aims to assess the challenges, opportunities, and enablers of delivery model integration of post-partum and post-abortion family planning with RMNCAN services in selected primary healthcare facilities in the Somali Region of Ethiopia.
Methodology: This formative assessment was done in eight primary healthcare settings of the Fafan and Jarar zones of the Somali Region, using qualitative research methods. Ethical clearance was obtained from the Institutional Review Board of the College of Health Sciences at Addis Ababa University, respondents were informed about the purpose of the study, confidentiality considerations were properly made and their consent was obtained. Key Informant interviews (KII), In-depth interviews (IDIs), and Focus group discussions (FGDs) were used to collect data. OpenCode 4.03 software was used to analyse the data.
Result: The post-partum and post-abortion family planning (PPPAFP) services uptake remains poor and key barriers such as limited PPPAFP service to health facilities, limited information, poor supply chain management of PPPA, poor community acceptance and low awareness of PPPAFP services and poor participation of women in health care budget allocation are negatively reinforcing the awareness, access, and utilization of FP service. Evidences also show that deviated decision-making of available assets and resources; mostly men, limited female participation in leadership roles and responsibilities, and negative cultural norms, and attitude towards family planning services in general were found to impede the services delivery. Conclusion and recommendations: It is noted that there is limited information regarding the availability of family planning services. In addition, there is poor supply chain management and poor community acceptance, and low awareness of PPPAFP. Therefore, the government and other stakeholders should facilitate the availability and accessibility of all FP methods and their information at the community, household, and individual levels; women empowerment should be in place to augment service uptake. Drawing from these findings, we also recommend Health education and counselling, availability & accessibility of family planning facilities and supplies, and community support groups for improving postpartum and post-abortion family planning use.