title: 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.
abstract: OBJECTIVE
  Postpartum women face uncertainty about timing of return to fecundity. Many women wait to use contraception until menses return, resulting in unintended pregnancies. This study explored the use of behavior change communication to address perceptions of postpartum return to fecundity and contraceptive adoption.
  
  
  METHODS
  This study, which took place in Sylhet District in Bangladesh, 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 fictional story ("Asma's Story") incorporated within community health activities. The study relied on in- depth interviews and focus group discussions.
  
  
  RESULTS
  The study revealed nearly universal exposure to Asma's Story. Reported shifts in perceived susceptibility to pregnancy, benefits of pregnancy spacing, and increased social support for postpartum family planning (PPFP) were noted. However, only approximately one third of women were using a modern contraceptive method.
  
  
  CONCLUSIONS
  Using a fictional story offers a promising approach for motivating shifts along the continuum.
  
  
  CONCLUSIONS
  It is 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.
authors.affiliation: Jhpiego, Baltimore, USA. Electronic address: chelsea.cooper@jhpiego.org.
authors.forename: Chelsea M
authors.initials: CM
authors.lastname: Cooper
authors.affiliation: Jhpiego, Baltimore, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Salahuddin
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
authors.affiliation: Jhpiego, Baltimore, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Pfitzer
authors.affiliation: Jhpiego, Baltimore, USA.
authors.forename: Catharine
authors.initials: C
authors.lastname: McKaig
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D000328:Adult; D001459:Bangladesh; D001721:Birth Intervals; D001942:Breast Feeding; D003267:Contraception; D003268:Contraception Behavior; D003469:Culture; D005193:Family Planning Services; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033262:Narration; D049590:Postpartum Period; D011247:Pregnancy; D012944:Social Support; D055815:Young Adult
keywords: Bangladesh; Behavior change communication; Breastfeeding; Entertainment education; Family planning; Narratives; Postpartum care; Postpartum family planning; Stages of change; Steps to behavior change