Evaluating two models of postpartum family planning counseling on contraceptive uptake, knowledge, and intended use: evidence from a repeated cross-sectional study in Ghana

Integrating family planning programming into postpartum care is widely established as an effective approach to improve access to family planning. We conducted a pilot study in 6 hospitals in northern Ghana to evaluate the effectiveness of two approaches at increasing voluntary contraceptive uptake. These approaches were family planning counseling during postnatal care (PNC) appointments and family planning messaging and referrals during immunization/child welfare clinic (CWC) sessions in the first year postpartum. This study took place at six hospitals in the Northern region of Ghana, selected to provide a representative sample of care across urban, peri-urban, and rural hospitals. This study used a two-arm non-randomized repeated cross-sectional design. We surveyed 205 women pre-intervention and 226 women post-intervention in person. Of these, we reached 102 women pre-intervention and 100 women post-intervention with a phone follow-up survey 2 weeks later. All study participants had delivered a live birth in the last 12 months and attended either a postnatal care or child immunization appointment on the day of surveying. We observed no statistically significant effects on contraceptive use (PNC: p = 0.446; CWC, p = 0.821) or intended contraceptive use (PNC: p = 0.998; CWC: p = 0.181) in either arm at immediate in-person surveying. At two-week phone surveying, respondents reported a 22% increase in contraceptive use (p < 0.001) and a 25.3% increase in intended use (p = 0.019) post-intervention in the PNC arm and no statistically significant effects in the CWC arm. However, substantial attrition between in-person and phone surveys (46.9% response rate) limits the interpretability of these findings. Prolonged postpartum abstinence in both arms (97.1% in the PNC arm and 75.1% in the CWC arm) suggests that the majority surveyed were not at high risk of pregnancy irrespective of modern contraceptive use. The intervention package produced no significant effects on contraceptive uptake at CWC, while producing mixed results at PNC. Prolonged postpartum abstinence suggests that changes in contraceptive uptake in the first year postpartum in similar contexts may have a reduced effect on unintended pregnancies; this supports similar recent findings in the literature. Data collection issues, along with the small sample size and non-randomized study design in this pilot, may limit the reliability and generalizability of the findings. Not applicable. Integrating family planning programming into postpartum care is widely established as an effective approach to improve access to family planning. We conducted a pilot study in 6 hospitals in northern Ghana to evaluate the effectiveness of two approaches at increasing voluntary contraceptive uptake. These approaches were: (1) family planning counseling during postnatal care (PNC) appointments and; (2) family planning messaging and referrals during immunization/child welfare clinic (CWC) sessions in the first year postpartum. This study used a two-arm non-randomized repeated cross-sectional design, surveying 205 women pre-intervention and 226 women post-intervention. We observed no statistically significant effects on actual or intended contraceptive use in either arm at immediate surveying. Results from two-week phone surveying suggest a 22% increase in contraceptive use and a 25.3% increase in intended use post-intervention in the PNC arm and no statistically significant effects in the CWC arm. However, substantial attrition between in-person and phone surveys limits our ability to draw robust conclusions from phone data. Prolonged postpartum abstinence suggests that the majority surveyed were not at high pregnancy risk irrespective of modern contraceptive use. While aspects of the study design limit the generalizability of the findings, the results suggest that contraceptive counseling at CWC may have limited effect on contraceptive uptake, while counseling at PNC is more promising yet still mixed. High rates of breastfeeding and prolonged postpartum abstinence suggest that changes in contraceptive uptake in the first year postpartum in similar contexts may have a reduced effect on unintended pregnancies; this supports similar findings in the literature.