Opportunities and challenges in integrating family planning and nutrition services in Tanzania: a mixed-methods study

Background Integration of family planning (FP) and nutrition is critical for improving maternal and child health, yet evidence on effective integration remains limited in Tanzania. This study explored challenges and opportunities for integrated service delivery in Tanzania. Methods A mixed-methods approach was used, combining analysis of the 2022 Tanzania Demographic and Health Survey (n=15, 254 women), a desk review of 25 national documents, and qualitative data from 18 focus group discussions and 14 key informant interviews in urban and rural areas. Thematic analysis and the Walt and Gilson framework guided qualitative and policy reviews, while Poisson regression assessed quantitative associations. Results Unmet FP needs were high (25%). Anaemia affected 40% of women, with 6% underweight and 30% overweight/obese. Our novel quantitative analysis revealed that hormonal contraceptive use was associated with 30%–40% reduction in anaemia risk, while short birth intervals doubled the risk of being underweight. Urban women faced higher obesity rates (24%) than rural women (12%). While national policies conceptually support integration, gaps in implementation, monitoring and cross-sectoral coordination persist, including siloed programme design, fragmented governance and a lack of joint operational guidance and monitoring frameworks. Stakeholders highlighted challenges to service integration, including fragmentation between FP and nutrition services, frequent stockouts, long wait times, stigma and limited male engagement. Key opportunities identified include strong community preference for bundled services, advocacy from faith leaders for mosque-based and church-based outreach, and the potential of digital platforms and private-sector partnerships to expand access. Conclusions Addressing integration gaps requires policies that prioritise underserved groups (eg, rural women, adolescents) and delivery models tailored to local contexts (urban vs rural), as well as strengthened implementation. Unified governance and community-based platforms, with integrated service delivery at health facilities and in the community, can enhance impact in Tanzania and similar settings.