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

Background Integrating family planning programming into postpartum care is widely established as an effective approach to improve access to family planning. We conducted a pilot in 6 hospitals in northern Ghana to evaluate the effectiveness of two approaches at improving 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. Methods This study used a two-arm non-randomized repeated cross-sectional design. We surveyed 205 women pre-intervention and 226 women post-intervention. Results We observed no statistically significant effects on actual or intended contraceptive use in either arm at immediate surveying. Results from two-week phone surveying (n = 202) suggest a 22% increase in contraceptive use ( p < .01) and a 25.3% increase in intended use ( p <.05) post-intervention in the PNC arm and no statistically significant effects in the CWC arm; however, this data is only suggestive due to its small sample size. High rates of breastfeeding and prolonged postpartum abstinence suggest that the majority surveyed were not at high risk of pregnancy irrespective of modern contraceptive use. Conclusions While the relatively small sample size and non-randomized 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 recent findings in the literature. Trial registration Not applicable.