From protection to empowerment : Uniting immunisation and family planning

Family planning allows individuals and couples to space pregnancies adequately, reducing health risks associated with closely spaced pregnancies such as preterm birth, low birth weight, and maternal and infant mortality. Closely spaced or unintended pregnancies can result in inadequate immunisation, stunting and adverse outcomes for the mother1. However, early marriage and childbearing are still prevalent in India, especially in rural areas where 9% of girls from 15-19 years have already begun childbearing, compared to 5% in urban regions leading to a higher risk of pregnancy-related complications among young girls, and contributing to increased maternal and infant mortality rates. Despite the widespread availability of modern contraceptive methods in India, a significant proportion of married women continue to rely on traditional methods for family planning, which unfortunately have high failure rates.

World Immunisation Week (April 24-30) is an opportune time to advocate for integrating family planning with immunisation services. The vast reach and use of immunisation programmes by millions of mothers in postpartum stage offers a unique opportunity to reach women with family planning services. This integration could significantly reduce the unmet need for effective contraception among new mothers, enhancing both maternal and child health. Child immunisation services create frequent interactions with mothers during the crucial postpartum period – 12 months following the birth, presenting multiple opportunities for healthcare providers to engage in family planning discussions with mothers. Such efforts can facilitate healthy birth spacing, thus, reducing unintended pregnancies and unsafe abortions. Integration will also ensure mothers receive accurate advice about family planning methods, supporting their and their children’s health. Consistent touch with postpartum women will not only increase the reach of family planning to underserved areas but also save time for both providers and clients.

Drawing inspiration from successful integration efforts in Rwanda, where the incorporation of family planning education into immunisation services led to increased contraceptive usage, India can forge a similar path toward holistic healthcare delivery. A research project conducted by FHI 360 and CARE India evaluated integrated health services in Lohardaga, Jharkhand under the National Rural Health Mission. The study, assessed how family planning was being incorporated into immunisation services. Researchers interviewed immunisation providers, and mothers attending immunisation sessions, and also analysed the scope for enhanced integration at various service points. The study found that reaching women during the extended postpartum period through child health and immunisation services could improve uptake of family planning. Moreover, this integration could significantly reduce reliance on less effective methods like the withdrawal and rhythm methods.

Though integration shows promise, it is not without challenges. The same study referenced above in Jharkhand's Lohardaga district, highlighted significant gaps in service delivery, as locations were crowded, did not have basic medical supplies and lacked private spaces for these services. The study suggested the need for standardised integration guidelines and comprehensive provider training to ensure consistent and high-quality service. To address these challenges, establishing a dedicated task force to create and enforce integration standards can ensure the successful union of family planning and immunisation services. For any service delivery model to be successful it’s important to address gender norms and beliefs which have a direct bearing on women’s reproductive autonomy and ability to decide on number and spacing of children. High quality integrated services that are client-centred and rights-based are therefore, central to successful uptake.

Integrating family planning with immunisation services is not just a medical decision; it’s a significant step toward women's empowerment. By combining these essential services, we can protect lives and empower families, enabling them to make informed decisions about their health and future. It’s a commitment to ensuring that every child is born healthy and into a world where their future is nurtured from the very start. This strategic approach is a journey from protection to empowerment, where every immunisation visit is a step toward a healthier future.

This article is authored by Dr Rajat Khosla, incoming executive director, PMNCGH and currently director, International Institute on Global Health at the United Nations University.