Integrating voluntary family planning and cervical cancer screening and preventative treatment: lessons from the MULHER study in Mozambique

Introduction: Mozambique faces a significant burden of cervical cancer, but screening rates are currently low. While voluntary family planning (vFP) services are more widely accessible, unmet need for contraception remains at 22%. Integrating vFP and cervical cancer screening and preventive therapy (CCS&PT) services presents an opportunity to address these issues by improving service efficiency and reaching more women. This paper examines the uptake, feasibility, and experiences of integrating vFP services into CCS&PT services in Mozambique. Methods: This mixed-methods operational research study was conducted in four public health facilities in Mozambique. Quantitative data were collected from January 2020 to October 2022 as part of the MULHER study and included program monitoring data from clinical encounters (N=9,014) and client exit interviews (N=504). Qualitative data was gathered through in-depth interviews (IDIs) with 60 clients and 15 providers in two phases, in October 2021 and November 2022. Results: Out of 9,014 women eligible for HPV screening, 88% received both HPV screening and vFP counselling. 21% of these women took up a modern method of FP, 20% of whom were new users. Multivariable analysis showed that the likelihood of receiving integrated services was significantly associated with a range of factors including parity, age and HIV status. Qualitative data revealed that both clients and providers generally perceived the integrated model as beneficial. Clients highlighted the convenience, enhanced privacy, reduced travel costs, and opportunity to learn about new services. Providers emphasized similar benefits alongside the potential for increased demand through peer referrals. Conclusions: Integrating vFP into CCS&PT services in Mozambique has the potential to increase vFP uptake, including among new users. The integrated model proved feasible and acceptable to both women and providers. The findings support the scaling up of this model to improve access to vFP and CCS&PT services and enhance women's sexual and reproductive health.