Policy-practice gaps and bottlenecks to postpartum family planning scale-up in the United Republic of Tanzania.
- 1National Institute for Medical Research, Headquarters, Dodoma, Tanzania.
Abstract
Background
Unintended and closely spaced births remain important public health concerns. Postpartum family planning provides an opportunity to prevent unintended pregnancies and improve maternal and child health outcomes. However, evidence on the implementation bottlenecks affecting PPFP scale-up in Tanzania remains limited.Aim
This study assessed implementation bottlenecks affecting the uptake, scale-up and sustainability of PPFP services in Tanzania and identified and prioritized potential actions to address them.Methods
A cross-sectional study employing a participatory mixed-methods approach was conducted using an adapted WHO PPFP bottleneck assessment tool, stakeholder survey, in-depth interviews, routine health information and population-based survey data, and review of national policies and guidelines. The online stakeholder survey included 477 invited participants, of whom 424 responded (88.9%). In-depth interviews were conducted with 34 stakeholders from regions representing high and low PPFP uptake. Findings from the different data sources were triangulated and presented during a stakeholder consensus meeting, where bottlenecks were ranked and prioritized and corresponding actions were identified.Results
Routine and survey data indicated substantial variation in PPFP uptake and an increase in postpartum FP counselling over time, but counselling did not consistently translate into PPFP uptake. The assessment identified gaps in provider capacity, motivation, financing, access to and awareness of updated policies and guidelines, referral systems, equitable access, and the scale-up of innovations. Policy reviews further identified gaps between national guidance and implementation, including limitations in dissemination, monitoring, and alignment with WHO recommendations. The consensus process prioritized actions addressing provider motivation, financing, dissemination of updated guidance and job aids, referral systems, equitable access, innovation scale-up, and provider capacity.Conclusion
Tanzania has a supportive policy environment for PPFP, but implementation remains constrained by interconnected health-system, provider, and service-delivery barriers. Addressing these bottlenecks through coordinated investments in financing, provider capacity and motivation, guideline dissemination, referral systems, equitable access, and scale-up of effective innovations is essential to strengthen PPFP implementation and uptake.
Related
- Postpartum needs and experiences of young and first-time mothers in northwestern Tanzania.
- Maternal bonding difficulties and postpartum depression in pediatric clinical practice: a longitudinal study in a Japanese cohort
- Association between interspousal communication on family planning and contraceptive use: a cross-sectional study in Temeke municipality, Tanzania.
- "She cannot use these methods before she has at least one child": a qualitative study on family planning attitudes, knowledge, and experiences among adolescent girls and young women living with HIV in Moshi, Tanzania.
- Hand-Washing Hygiene Knowledge, Attitude and Practice among University Students in the Post-COVID-19 Era: A Case of KCMC University, Moshi, Tanzania
BibTeX
@article{kafaiya2026policypractice,
title = {{Policy-practice gaps and bottlenecks to postpartum family planning scale-up in the United Republic of Tanzania.}},
author = {Charles Basil Kafaiya and Stella P Kilima and Mary T Mayige and Kijakazi O Mashoto},
journal = {Frontiers in global women's health},
year = {2026},
month = oct,
doi = {10.3389/fgwh.2026.1875076},
url = {https://europepmc.org/article/MED/42948068},
note = {CC BY},
}
RIS
TY - JOUR
TI - Policy-practice gaps and bottlenecks to postpartum family planning scale-up in the United Republic of Tanzania.
AU - Charles Basil Kafaiya
AU - Stella P Kilima
AU - Mary T Mayige
AU - Kijakazi O Mashoto
PY - 2026
DA - 2026/10/13
JO - Frontiers in global women's health
DO - 10.3389/fgwh.2026.1875076
UR - https://europepmc.org/article/MED/42948068
AB - Background Unintended and closely spaced births remain important public health concerns. Postpartum family planning provides an opportunity to prevent unintended pregnancies and improve maternal and child health outcomes. However, evidence on the implementation bottlenecks affecting PPFP scale-up in Tanzania remains limited.Aim This study assessed implementation bottlenecks affecting the uptake, scale-up and sustainability of PPFP services in Tanzania and identified and prioritized potential actions to address them.Methods A cross-sectional study employing a participatory mixed-methods approach was conducted using an adapted WHO PPFP bottleneck assessment tool, stakeholder survey, in-depth interviews, routine health information and population-based survey data, and review of national policies and guidelines. The online stakeholder survey included 477 invited participants, of whom 424 responded (88.9%). In-depth interviews were conducted with 34 stakeholders from regions representing high and low PPFP uptake. Findings from the different data sources were triangulated and presented during a stakeholder consensus meeting, where bottlenecks were ranked and prioritized and corresponding actions were identified.Results Routine and survey data indicated substantial variation in PPFP uptake and an increase in postpartum FP counselling over time, but counselling did not consistently translate into PPFP uptake. The assessment identified gaps in provider capacity, motivation, financing, access to and awareness of updated policies and guidelines, referral systems, equitable access, and the scale-up of innovations. Policy reviews further identified gaps between national guidance and implementation, including limitations in dissemination, monitoring, and alignment with WHO recommendations. The consensus process prioritized actions addressing provider motivation, financing, dissemination of updated guidance and job aids, referral systems, equitable access, innovation scale-up, and provider capacity.Conclusion Tanzania has a supportive policy environment for PPFP, but implementation remains constrained by interconnected health-system, provider, and service-delivery barriers. Addressing these bottlenecks through coordinated investments in financing, provider capacity and motivation, guideline dissemination, referral systems, equitable access, and scale-up of effective innovations is essential to strengthen PPFP implementation and uptake.
SN - 2673-5059
ER -