Findings from the use of a narrative story and leaflet to influence shifts along the behavior change continuum toward postpartum contraceptive uptake in Sylhet District, Bangladesh

Publish Date: September 2014
Author: Chelsea Cooper, Salahuddin Ahmed, Peter Winch, Anne Pfitzer, Catharine McKaig, Abdullah Baqui
Language: English

The journal Patient Education and Counseling published the MCHIP co-authored article, “Findings from the use of a narrative story and leaflet to influence shifts along the behavior change continuum toward postpartum contraceptive uptake in Sylhet District, Bangladesh.”

The article describes a study in Sylhet District, Bangladesh, that explored knowledge and perceptions about postpartum return to fecundity and used the Steps to Behavior Change framework to assess the reported influence of a leaflet and a fictional story that had been incorporated within community health activities. Community health workers shared and discussed the leaflet and story during family planning counseling sessions with postpartum women, and community mobilizers did the same during group meetings with mothers-in-law, postpartum women, and men.

The leaflet included “Asma’s story” with accompanying drawings on one side and critical messages about return to fecundity on the reverse. The story tells how one woman, Asma, incorrectly assessed her risk of pregnancy to be minimal during the months before her menstruation returned. The study used in-depth interviews and focus group discussions with postpartum women and their mothers/mothers-in-law and husbands; these revealed nearly universal exposure to Asma’s story.

Respondents cited the story as an important contributor to shifts in their postpartum family planning (PPFP) knowledge, perceptions, and practices. The story seemed to resonate on a personal level with many respondents, who indicated that they or their family members/peers had experiences similar to Asma’s. While shifts in perceived susceptibility to pregnancy, benefits of pregnancy spacing, and increased social support for PPFP were noted, only about one-third of women were using a modern contraceptive method.

The authors concluded that fictional stories presented in leaflet and oral form during home visits and group discussions provide a promising approach to building support for PPFP uptake, but that remaining barriers to PPFP use must also be addressed. Their findings reinforce the importance of tailoring social and behavior change strategies to respond to the unique needs of postpartum women at various stages of the behavior change continuum, as barriers and motivating factors vary by stage. The authors recommended that Asma’s story be incorporated within future efforts to scale up PPFP in Bangladesh and that similar approaches be tailored and tested in other countries.

To read the full article, click here.