What mechanisms drive uptake of family planning when integrated with childhood immunisation in Ethiopia? A realist evaluation

Abstract Background Maternal and child health are key priorities among the Sustainable Development Goals, which include a particular focus on reducing morbidity mortality women of reproductive age, newborns, children under age five. Two components maternal family planning (FP) immunisation. Providing these services through an integrated delivery system could increase uptake vaccines modern contraceptive methods (MCMs) particularly during post-partum period. Methods A realist evaluation was conducted in two woredas Ethiopia to determine mechanisms their triggers that drive successful implementation service intervention immunisations FP. The methodological approach included development initial programme theory selection relevant, published related theoretical frameworks aid organisation cumulation findings. Data from 23 semi-structured interviews were then analysed empirical drivers test theory. These mapped against revised comprised context-mechanism-outcome configurations developed. critique for abstracting also conducted. Results Key contextual factors identified were: use trained Health Extension Workers (HEWs) deliver FP services; strong belief values challenged religious leaders community members; lack support male partners based values. Within contexts, acceptability, access, adoption innovations drove decision making outcomes workers, leaders, members describe implementation. Conclusions Linking context they triggered helped explain outcomes, more broadly how whom worked. constructs provided level abstraction findings be cumulated across time, space, conditions by theorising middle-range mechanisms.