Abstract
BACKGROUND: Over the past 30 years, Ethiopia has significantly invested in its primary health care (PHC) system, improving access to health services and overall health outcomes. However, gaps persist in delivering comprehensive reproductive, maternal, newborn, and child health (RMNCH) services. Although Ethiopia's policy framework supports integrated PHC services, RMNCH programs often operate independently, resulting in fragmented care and missed opportunities, especially in rural and pastoral regions with limited access. This study examined current practices in integrated service delivery and the association between integrated service delivery and the adoption of postpartum family planning (PPFP) and immunization services. METHODS: From July to August 2024, we conducted formative implementation science research utilizing household surveys and facility assessments. A stratified multistage sampling technique recruited 1,922 women with infants ages 0-11 months across agrarian and pastoral regions, along with data from 67 facilities. The study assessed the association between integrated family planning, maternal and newborn health, and immunization service delivery with postpartum family planning and immunization practices in Ethiopia. Data were analyzed using Stata 15.1, employing Pearson's chi-square test, post-stratification sampling weights, and random-intercept logistic regression models to estimate associations between individual- and community-level variables and the likelihood of adopting PPFP and child vaccination. RESULTS: Overall, the availability and integration of essential job aids and services varied considerably by setting, with pastoral areas consistently showing lower coverage across RMNCH touchpoints. Approximately 45% of mothers adopted PPFP, with significant regional variations, particularly lower rates in pastoral areas. About one-third received PPFP counseling during antenatal care contacts, and over three-fourths received immunization counseling during childbirth. Women who received counseling about PPFP during childbirth had 2.6 times higher odds of adoption (AOR: 2.60; 95% CI: 1.61-4.20), while those counseled during both antenatal care (ANC) and childbirth had four times higher odds (AOR: 4.06; 95% CI: 2.49-6.63). Counseling on immunization during or after childbirth increased child vaccination odds threefold (AOR: 3.39; 95% CI: 1.80-6.41), while women who did not receive integrated services during childbirth had 78% lower odds of vaccination (AOR: 0.22; 95% CI: 0.14-0.34). Women in agrarian communities and those receiving postpartum care within six weeks also had higher odds of adopting PPFP and vaccination services. CONCLUSIONS: The study highlights observed associations between service integration and uptake of maternal and child health services, indicating variation across contexts and the importance of considering these patterns in efforts to improve service delivery.