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

•We explore knowledge and perceptions about postpartum return to fecundity in Sylhet, Bangladesh.•We use steps to behavior change to assess reported influence of a fictional story/leaflet.•Reported shifts in perceived susceptibility to pregnancy, pregnancy spacing benefits, and social support for PPFP were noted; barriers to PPFP uptake remain.•Using a fictional story offers a promising approach for motivating shifts along the continuum; remaining barriers to PPFP use must be addressed.•Consider incorporating Asma's Story in scale-up of PPFP in Bangladesh; tailor/test in other countries.

ObjectivesPostpartum 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.MethodsThis 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.ResultsThe 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.ConclusionsUsing a fictional story offers a promising approach for motivating shifts along the continuum.Practice implicationsIt 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.