Opportunities and challenges for integrating family planning and nutrition policies and programmes in Burkina Faso: a mixed-methods study

BACKGROUND: Despite known linkages between family planning (FP) and nutrition, there is little evidence on whether and how these services are integrated for women of reproductive age (WRA; aged 15-49 years) in Burkina Faso. This study aimed to obtain an overview of FP and nutrition policies and programmes in Burkina Faso to understand the value, current efforts, gaps and opportunities for integration. METHODS: In this mixed-methods study, we analysed recent Demographic and Health Survey Demographic and Health Survey (2021) data using survey-adjusted tabulation and Poisson regression models to assess population-level FP and nutrition needs and inter-relationships. We also conducted a desk review of 27 policies and programmes targeting nutrition and/or FP and their integration, analysed using Walt and Gilson's triangular framework. Finally, we conducted a series of in-depth interviews with policy and programme leaders and focus group discussions with WRA and other community members to determine perspectives and experiences on FP and nutrition service integration (n=144), with data analysed using thematic analysis. RESULTS: We found a high prevalence of unmet need for FP (18.3%, 95% CI 17.3 to 19.3) and of indicators of poor nutrition (moderate anaemia: 29.3%, 95% CI 28.0 to 30.7) among WRA. Use of hormonal contraceptives was associated with reduced anaemia risk (risk ratio for injections: 0.72, 95% CI 0.65 to 0.80, p<0.001). Alignment of FP and nutrition was noted in 9/27 policy and programme documents, especially within the context of maternal and child healthcare services. Interviewees recognised the health-related, resource-related and logistical (to WRA) benefits of integrating FP and nutrition services particularly for maternal and child well-being, but financial, logistical and cultural barriers were emphasised. CONCLUSIONS: Integrating FP and nutrition services is a potentially valuable and impactful approach to improve health in WRA in Burkina Faso. However, this view is not universal, and effectively consolidating integration will require targeted efforts to address barriers at multiple levels.