Despite a near-universal desire worldwide to avoid pregnancy in the postpartum period (the year after delivery), during this time fewer than half of women worldwide are using modern forms of contraception, elevating the risk of both maternal and infant morbidity and mortality.
Inspired by her work as a consultant for the World Health Organization (WHO), Sarita Sonalkar, MD, MPH, an assistant professor of Obstetrics and Gynecology at Penn Medicine, has spent the past seven years working to develop technologies that allow providers to offer easily accessible contraception and comprehensive guidance to their patients.
Postpartum Resources and Education
The need for these technologies is driven by factors that evolve in the weeks after delivery to influence the decision to initiate hormonal and non-hormonal contraception, including the risk of blood clots in the legs and lungs, the changing size of the uterus, breastfeeding, and, in the case of intrauterine devices, expulsion risk.
During her work surrounding postpartum family planning guidance development with WHO, Dr. Sonalkar found that resources and education for postpartum patients were not readily available. While guidance on family planning in the postpartum period could be found in a variety of published WHO documents, each focused on different aspects of family planning care.
“Providers navigating the medical complexities of family planning in the postpartum period face enormous challenges,” Dr. Sonalkar says. “What they need is quick, accessible and individualized references for their patients—and it just wasn’t there."
To fill this need, Sonalkar and her team developed the WHO Postpartum Family Planning Compendium, a web-based platform that integrates WHO guidance regarding postpartum family planning that incorporates concerns about timing postpartum, breastfeeding, and other health considerations. Because it was purely web-based and required Internet connection, the idea evolved to develop a mobile version of the application.
World Health Organization Postpartum Family Planning App
The WHO Postpartum Family Planning Compendium mobile app was created as a family planning tool for providers worldwide that gives women evidence-based recommendations for family planning.
The app consists of a type of calculator where personalized information about the patient is plugged in. Questions such as:
- How many weeks or months has it been since delivery?
- Are there any medical comorbidities?
- Is she breastfeeding?
The patient’s information is combined to output a variety of contraceptive options that are safe and appropriate to use. Additional information about each contraceptive is also provided including effectiveness, proper use, and side effects.
The Compendium's homepage consists of two sections: dropdown menus that allow the user to select characteristics of a woman in the postpartum period needing family planning services, and a chart of family planning methods arranged by timing eligibility in the postpartum period. Users may select comorbid conditions, breastfeeding status and personal characteristics (e.g. smoking or adolescence) that may affect a woman's eligibility for a specific method, and selects the timing in the year after delivery.
The user can then click on each family planning method to see whether the woman in question is eligible for that method on the basis of the characteristics selected. Both general information on the contraceptive method and relevant information from WHO family planning guidelines are then displayed. The user‐friendly interface allows for easy toggling between conditions and among contraceptive methods.
This technological innovation streamlines all of the complicated recommendations surrounding postpartum family planning to help women access safe contraceptive options and gain accurate information and education. The technology also makes it easier to make informed choices, including whether a person is eligible for birth control methods that are acceptable for women who are breastfeeding or who have just delivered a baby.
The current mobile application allows use on smartphones without dependence on connectivity, and an upcoming app revision will incorporate many more medical conditions and personal characteristics that can influence contraceptive choice. In the future, the app will allow the potential for personalization to the provider via geolocation, taking into account language, cultural, and access differences in populations.
So far, the application shows great promise, according to Dr. Sonalkar.
“In interviews, we found that providers truly appreciated the comprehensive nature of the guidance provided in the WHO Postpartum Family Planning Compendium mobile app, and use it with regularity when seeing patients,” she says. “We are now working on testing whether it changes the degree to which providers recommend contraception postpartum.”