Misconceptions about timing of return http://www.selleckchem.com/products/ly2109761.html to fecundity and factors affecting postpartum pregnancy risk can lead to delays in timely contraceptive initiation [4]. This study is a sub-study of the Healthy Fertility Study (HFS),2

which was conducted in Sylhet District in northeastern Bangladesh [8]. In Sylhet District, in 2011, almost half (46.5%) of non-first births occurred at short intervals of less than 36 months since the previous birth [9]. Under-five and neonatal mortality and total fertility are higher, and contraceptive prevalence is lower in Sylhet Division compared to the rest of Bangladesh [9]. HFS promoted optimal pregnancy spacing by integrating postpartum family planning (PPFP) within a community-based maternal and newborn health program. Within HFS, female community health workers (CHWs) counseled women on PPFP and provided contraception to women during household visits. Community mobilizers convened group discussion sessions with women, husbands, mothers/mothers-in-law, and other community members. In order to address noted gaps in PPFP knowledge and understanding,

the HFS study team developed a leaflet including “Asma’s Story” and a pictorial on one side, and critical messages about return to fecundity on the reverse. The leaflet and story (Fig. 1) were shared and discussed with women during counseling sessions with postpartum women and group meetings with mothers-in-law, Epigenetics inhibitor postpartum women, and men. Asma’s Story tells how one woman (“Asma”) incorrectly assessed her risk of pregnancy to be minimal during the months before her menstruation returned. Asma says she will wait until her menstruation

returns before starting a modern FP method, but then becomes pregnant. She learns that conception can occur until before menstruation returns, and it is important to start using an FP method soon after giving birth. This study was designed to assess: knowledge and perceptions regarding return to fecundity among postpartum women, husbands, and mothers/mothers-in-law; short-term outcomes of efforts to raise awareness about postpartum return to fecundity and encourage PPFP use; and the ways in which the approach may have affected postpartum women’s progression along the steps to behavior change (SBC) continuum toward modern contraceptive use. The study aimed to contribute to emerging global knowledge about behavioral approaches for PPFP in order to inform future efforts in Bangladesh and globally. Postpartum women were the main respondents for this study. Focus groups with husbands and mothers/mothers-in-law were also included with the understanding that decisions about contraceptive use are not necessarily taken by the woman alone. Formative research conducted at the outset of HFS identified husbands and mothers/mothers-in-law as key influencers of FP decisions [10].