Integrated Care and Conditional Health Benefits: A Mixed-Methods Study of Family Planning Impact on Maternal and Child Health among Married Women in Bo City, Sierra Leone

Background: Health benefits from family planning (FP) are well established, yet little is known about how health benefits from FP are experienced in low-resource settings. This study assessed the self-reported association of FP on maternal and child health among married women in Bo City, Sierra Leone, and explored the mechanisms or pathways through which FP benefits are experienced. Methods: A mixed-methods cross-sectional study design was used. A total of 1500 married women aged 15 - 49 years from 25 enumeration areas in Bo City were studied using a structured questionnaire. In-depth interviews (IDIs) were conducted with 20 married women, while 5 focus group discussions (FGDs) were held with married women, men, elders, and health care providers from the study areas. Results: Findings showed that 83.0% of married women using FP reported positive child spacing outcomes, while 76.8% reported prevention of unintended pregnancy. The interaction FP × High Parity showed that the perceived benefits of FP concentrate among high-parity women (aOR = 2.45; 95% CI: 1.28 - 4.4.69; p = 0.0077). The FP × Regular ANC interaction showed that combined FP and ANC was associated with reduced pregnancy complications by 52% (aOR = 0.48; 95% CI: 0.24 - 0.96; p = 0.033). Non-users had 96% higher odds of reporting no improvement in child health (aOR = 1.96; 95% CI: 1.50 - 2.57; p < 0.001) and almost 4 times higher odds of being unsure about benefits (aOR = 3.88; 95% CI: 2.63 - 5.73; p < 0.001). Thematic analysis of qualitative accounts identified four key themes that explained health benefits from FP, including maternal depletion prevention, integrated care synergies, resource allocation, and benefit invisibility. Conclusions: The perceived health benefits of FP are conditional and concentrated among high-parity women and those with access to antenatal care. Targeting high-parity women and integrating FP into ANC and child health services are recommended.