The Challenges of Integrating Family Planning and HIV Services: An Analysis of Programmer and Policymaker Opinions in Malawi, Nigeria, and Senegal

Rachel S. Robinson, American University

In sub-Saharan Africa, pregnancy and HIV are “transmitted” in primarily the same way: through unprotected, heterosexual sex. And in most African countries, there are more pregnancies than desired, and certainly too many new cases of HIV. These similarities alongside patterns of health care access and differential funding streams suggest that integrating family planning and HIV services should lead to better outcomes. But despite years of talk about the benefits to integration, it remains more rhetoric than reality. Why? Based on interviews I conducted with more than 90 people working for federal ministries, donor organizations, and local nongovernmental organizations in Malawi, Nigeria, and Senegal, I show that donor and government structures combined with overburdened primary health care providers are the primary obstacles to integration. I find, however, that in Malawi and Senegal, programmers are trying to use the distinctions between pregnancy and HIV prevention to benefit those they serve.