A contraceptive decision support tool and maternal and child outcomes - Despite almost all postpartum women wanting to delay their next pregnancy by at least two years, contraceptive use remains inconsistent, particularly in Ghana, which has one of the highest levels of unmet needs for family planning in sub-Saharan Africa. Prior research has shown the quality of contraceptive care in Ghana is poor, with many women adopting methods known to cause side effects women indicated were unacceptable to them. Contraception is a preference-sensitive health service; there are often multiple medically appropriate options available to women, and so their own preferences ought to drive the decision of whether or not to use contraception, and if so, which method. Increasing client autonomy has been recognized as the next frontier in improving the quality of contraceptive care women receive. In this project, our longstanding collaborative, cross-national, interdisciplinary team will tailor an mhealth intervention to postpartum women and follow them for two years post-delivery to determine the impact of the tablet-computer based decision-support tool on contraceptive autonomy, maternal mental and physical health, and health of the index baby. This study, conducted by a collaborative team from the University of Michigan and the Kwame Nkrumah University in Ghana, aims to improve the understanding and usage of postpartum contraceptives and the impacts of using My Family Planning-Ghana (MFPG), an adaptation of a US-based decision-support tool. To achieve this, the project focuses on three objectives. The first aim is to adapt MFPG for postpartum women, including those undecided about contraception, using the ADAPTITT framework. By testing the tool in postnatal and child welfare clinics, our goal is to make the tool feasible, acceptable, and sensitive to the needs of postpartum women. In the second aim, we will assess the tool's impact on contraceptive behavior through a cluster-randomized controlled trial. This study will enroll pregnant women in their third trimester and follow them for twenty-four months to determine whether the tool increases contraceptive autonomy, access to preferred methods, and selection of methods that meet users’ preferences. It will also assess the tool's impact on birth spacing, pregnancy outcomes, maternal health, and contraceptive autonomy over a two-year period. The third aim will examine whether using the decision-support tool is associated with improved health outcomes and resource investment for infants and children. The study will assess whether children of women in the intervention group have superior nutritional status, growth, health, breastfeeding duration, and healthcare usage compared to those in control group. This project provides an opportunity to improve contraceptive autonomy in the postpartum period, a global issue of which poor quality contraceptive care is a significant part. The intervention seeks to empower women to use contraception that meets their preferences if they want to and assists in achieving their fertility goals and healthy birth spacing, and could be adapted for use in other countries, including the United States. The research team combines expertise and exceptional research infrastructure to conduct a feasible, rigorous study of a tool with potential for high impact.
