Project Summary/Abstract
Maternal mortality continues to be the second leading cause of death for women of reproductive age around
the world. Maternal mortality is contributed to by unplanned, or mistimed pregnancies, that is, pregnancies that
occur at a time the mother is not prepared for, or too soon after a previous birth. Unplanned pregnancies are
associated with low birth weight, delayed access to prenatal care, and other health concerns for women and
babies. Unplanned pregnancy occurs disproportionately among low-income women, women of color, and
immigrant women. Rates of unplanned pregnancy can be reduced through the use of family planning, which
include natural methods, and use of contraceptives, whether hormonal or otherwise. Contraception use allows
women to decide whether, and when to have children. In addition, planning, postponing and spacing births,
allows women to achieve educational and career goals.
Family planning access is influenced by factors such as access to health care, fear of adverse effects,
proliferation of misinformation about family planning methods, and fear of a partner or family member’s
reaction to use. These concerns are amplified in vulnerable and underserved populations, such as in immigrant
communities, where social ties, and connections with the larger healthcare system may not be as strong. In the
U.S., a particularly marginalized group is that of African immigrant women (including African refugee women),
a steadily increasing population, who have been reported to have overall poorer reproductive health outcomes
due to decreased access to health care, language barriers, low socioeconomic status, and potentially lower
education levels. Therefore, the objective of this R21 application is to address important gaps in the
healthcare environment by providing salient and meaningful contraceptive information for African refugee
women who may not speak English, and have low literacy levels.
The specific aims are to: 1) adapt an existing web-based family planning intervention into a culturally congruent
family planning smartphone-based intervention, and 2) assess the feasibility, acceptability, and preliminary
efficacy of the developed smart-phone based intervention.
This intervention will be designed to increase access to information by providing self-paced, science-based
education. Findings from the feasibility and usability study will allow the research team to gather information on
the processes, resources, and scientific feasibility of the approach. This preliminary assessment will provide
formative data that will inform the development of a well-designed future R01 implementation trial. It is also
anticipated that this intervention could be trialed in in a larger sample of the population. The use of a cellphone
application is an innovative method that allows for self-paced, yet wide spread dissemination of the
intervention.