Integrating maternal, neonatal, and child health and nutrition and family planning: A systematic review

The Global Health Initiative emphasizes integrating health programs, but there is limited evidence guiding the integration of maternal, neonatal and child health and nutrition (MNCHN) services with family planning (FP) services. We conducted a systematic review to examine the evidence base for integrating MNCHN and FP services. Cochrane methods were used to search and screen the literature. Inclusion criteria were: 1) peer-reviewed publication through April 2010; 2) pre-post or multi-arm study design; 3) organizational strategy aimed at integrating MNCHN and FP service delivery. Rigor scores were assigned using a 9-point scale. 29 interventions met the inclusion criteria; 7 were randomized trials. The average rigor score was 3.2 out of 9. There was heterogeneity in study objectives and designs, types of interventions, locations, and outcomes. Overall, integration was found to be feasible with many positive outcomes, although many studies reported mixed or no effect on some outcomes. When measured, most studies found an increase in uptake of services, improvement in quality of care, and cost-effectiveness with integrated compared to non-integrated services. Factors promoting successful integration included effective provider training and supervision, providing a large selection of contraceptives, client-centered counseling, involvement of men and traditional health workers, and availability of a clinic with high-quality services. Gaps in the literature include nutrition services integrated with FP, interventions targeting men or couples, and studies measuring long-term effects. Program managers and policy makers should consider integrating MNCHN and FP services when feasible, although more research is needed.