TABLE 1.

Main Characteristics of the Included Studies, by Intervention Type

Study	Country and Setting	Participant Characteristic at Enrollment	Intervention Components	Timing and Dose
Counseling interventions
One-to-one
Ndegwa, 2014³²	Kenya, HF: hospital	Pregnant women: 36 weeks gestation or more, attending ANC clinic at study site	ANC+: In-person intensive counseling with trained counselor was an extra effort to enhance informed decision-making.	Not specified.
Adanikin, 2013³⁹	Nigeria, HF: tertiary hospital (referral center), obstetrics/gynecology department, obstetric units	Pregnant women: 28–37 weeks gestation, booked at study hospital	ANC only: In-person counseling with trained senior registrar covered information on genitalia, ovulation, fertility following birth, and modern and traditional FP methods.	3 sessions, third trimester.
Camara, 2018⁴³	Guinea, lower-level HF: 5 health centers	Pregnant women: 6 months gestation or more, attending ANC visits at study health centers	ANC only: In-person counseling with trained ANC provider focused on PPFP methods (modern and traditional).	Once (15–20 minutes); during ANC visits.
Ayiasi, 2015⁴⁶	Uganda, lower-level HF: 16 health centers	Pregnant women: 28 weeks gestation or less attending health centers for ANC	ANC only: During home visits and phone consultations, CHWs discussed risk of pregnancy soon after delivery, available options for delaying next pregnancy, and importance of regular and EBF to delay pregnancy. Women also offered phone consultations with health workers for advice.	Dose not specified; prenatal period.
One-to-one plus pamphlet
Keogh, 2015⁴⁰	Tanzania, lower-level HF: 14 antenatal clinics	Pregnant women: 3 months gestation or more	ANC only: In-person counseling with HIV post-test counselors covered benefits of spacing and limiting births; postpartum fertility and LAM; suitability of LAM based on breastfeeding plans; availability and suitability of FP methods for clients; role of condoms; referral to FP clinic and pamphlet, which covered PPFP, FP methods, and their suitability for couples living with HIV.	10 minutes of contraceptive advice after HIV post-test counseling session.
One-to-one with spouse involvement
Abdulkadir, 2020³⁸	Nigeria, HF: tertiary hospital, obstetrics/gynecology department, antenatal clinic	Pregnant women: 15-45 years, 32-38 weeks gestation, attending ANC at study hospital	ANC only: In-person antenatal counseling with principal author using a validated tool that includes information about the FP methods.	2 sessions; first 1 during third trimester and second 14 weeks later.
Mixed couple and group session
Daniele, 2018³⁶	Burkina Faso, lower-level HF: 5 (large) PHCs	Pregnant women and their male partners aged 15–45 years, 20–36 weeks gestation, attending routine check-ups at study health centers	ANC+: Private counseling sessions with auxiliary midwives or midwives covered importance of ANC and PNC, birth preparedness and signs of labor, danger signs for mother and newborn child, EBF, healthy timing and spacing of pregnancies, and PPFP. Group sessions focused on role of male partners.	3 sessions (1 hour each): group discussion between 20 weeks gestation and term, first counseling session between 20 weeks gestation and term, second session before postpartum discharge.
Digital interventions: SMS
Unger, 2018³¹	Kenya, lower-level HF: government health center (MCH clinic)	Pregnant women aged 14 years or older, less than 36 weeks gestation, attending ANC at study center	ANC only: Participants classified into tracks (routine, adolescents 14–19 years, first-time mothers, women with previous cesarean delivery, and those with multiple gestations) with tailored messaging. Personalized approach that provided gestational age-appropriate educational and counseling messaging. SMS topics on ANC, FP, infant health, etc.	Weekly SMS: from enrollment to 12 weeks postpartum.
Harrington, 2019³³	Kenya, HF: 2 public hospitals	Pregnant women and their male partners aged 14 years or older, 28 weeks gestation or more, attending ANC at study hospitals	ANC+: SMS covered general perinatal topics, and FP: available methods and their effectiveness, postpartum pregnancy risk, contraceptive safety during lactation, anticipatory guidance about side effects, community misperceptions, and dual protection.	Once a week, from enrollment (ANC visits) to 6 months postpartum.
Educational interventions
Campaign
Sebastian, 2012⁵⁴	India, community: 1 district, 4 blocks, 48 villages	Pregnant women aged 15–24 years, 4–7 months gestation, max. 1 previous child	ANC only: Community workers provided counseling on healthy timing and spacing of pregnancy; postpartum care, the LAM and PPFP; educational campaign for husbands and males in community on maternity care.	During pregnancy; dose not specified.
Group sessions
Maldonado, 2020³⁵	Kenya, community: 4 subcounties, 77 community health units	Pregnant women: 32 weeks gestation or less, women attending ANC at a health facility	ANC+: In-person community health volunteer group educational sessions cover health and social topics relevant to antenatal, postpartum, and early childhood experiences (with an optional financial savings program).	2 60–90 minute sessions per month.
Bang, 2018⁴¹	Ethiopia, community: 1 district, 2 villages	Women aged 15–49 years, pregnancy status not specified	ANC+: In-person village-level sessions covered FP, safe delivery, and postpartum care. Small group classes covered FP, ANC, institutional birth, postnatal management, and neonatal/child care. One education session was given to male community leaders to encourage paternal participation in FP. Mass media was used to improve women’s awareness of maternal health. On-the-job training sessions for providers to improve their capacity in practice and provide quality of care to women. Education and mobilization of Health Development Army members to help women in their villages improve awareness of maternal health.	Interventions implemented over 2.5-year study period. 2 village-level education sessions (reaching 196 women); 39 small group classes with 3 sessions each (reaching 2,576 women).
Lori, 2018⁴²	Ghana, HF: district hospital	Pregnant women aged 18 years or older, 14 weeks gestation or less	ANC only: In-person educational content and group peer support. One ANC visit dedicated to FP and EBF as a LAM.	Women encouraged to attend 7 ANC visits.
Sarnquist, 2014⁴⁸	Zimbabwe, lower-level HF: 4 public polyclinics	Pregnant women: HIV-positive, aged 18–40 years, 26-38 weeks gestation, attending ANC at study clinics	ANC only: In-person trainers offered sessions focused on sexual negotiation skills and empowerment, information about HIV, prevention of mother-to-child HIV transmission, FP, and communication skills related to sex and FP. Various learning techniques were used, including discussions, behavior modeling, songs/ dramatizations, and role-playing.	3 90-minute group sessions; most sessions happened in antenatal period; however, 21 32% of women had at least 1 session after delivery due to late study entry or early delivery.
Financial interventions
Client vouchers
McConnell, 2018³⁴	Kenya, lower-level HF: 2 private maternity clinics	Pregnant women aged 18-40 years, 7 months gestation or more, attending ANC at study clinics	ANC+: Vouchers given in person for free modern methods or counseling on LAM valid for 1 year and a time-limited voucher that expired 8 weeks after the estimated date of delivery. Value of voucher from US$0.92– US$6.45 depending on method; SMS reminders to use vouchers.	Vouchers given during ANC (7+ month gestation); SMS given at 5 weeks postpartum.
Pay-for-performance
Engineer, 2016⁵²	Afghanistan, lower-level HF: 442 facilities offering basic package of health services	Postpartum women: ever married, aged 12–49 years, up to 2 years postpartum Children: less than 5 years	ANC+: Facilities were given quarterly bonus payments based on MCH services provided: first ANC visits 1–4, skilled birth attendance cases, PNC visits 1–2, pentavalent 3 vaccination, and TB case detection. Additional annual payments also made based on 2 measures of equity of service provision, a balanced scorecard that addresses quality of services, and contraceptive prevalence rates in HF catchment areas.	Bonus amounts paid were about 6%–11% above their base salary in 2011 and increased to about 14%–28% in 2011, depending on the health worker’s cadre.
Package of interventions
Digital and one-to-one
Jiusitthipraphai, 2015⁵⁵	Thailand, HF: teaching hospital	Pregnant women aged 15–19 years, gestational age not specified, women who delivered and received antenatal/postnatal care at study hospital	ANC+: In-person motivational lessons covering impacts of adolescent pregnancy, preventing subsequent pregnancies by taking oral contraceptive, mechanism of oral contraceptives, correct taking methods, forgetting to take the contraceptive, and sources of assistance. Provision of a handbook to participants. Nurses were meant to praise and encourage participants.	3 sessions: antenatal, immediate postpartum, up to 6 weeks postpartum. Weekly phone calls (5–10 minutes) for 4 weeks in postpartum period.
Multifaceted
Guo, 2022²³ Huber-Krum, 2020²⁴ Pradhan, 2019²⁵ Puri, 2021²⁶	Nepal, HF: 6 tertiary hospitals	Postpartum women: women delivering in study hospitals (recruited after delivery and before discharge)	ANC+: FIGO’s PPIUD intervention: Training of providers (to improve counseling), information leaflet provision, establishing an information wall chart and video broadcast, training and supplies for PPIUD insertion/removal techniques, and complication management. Women received free in-person general counseling from community health volunteers on various FP methods and PPIUD-specific counseling on advantages and disadvantages, potential side effects, how to seek removal, and how long it protects from pregnancy. All counseling services, contraceptive use, and IUD removals were free.	Counseling occurred during routine ANC, at early labor, and after delivery but before discharge from hospital; provision of PPIUD in immediate postpartum and before discharge.
Karra, 2019²⁷	Sri Lanka, HF: 6 tertiary hospitals	Postpartum women: women delivering in study hospitals (recruited after delivery and before discharge)	ANC only: FIGO’s PPIUD intervention: Training of providers (to improve counseling), information leaflet provision, establishing video broadcast, training and supplies for PPIUD insertion, monitoring and evaluating of counseling services.	Counseling occurred during routine ANC or after admission for delivery; provision of PPIUD in the immediate postpartum and before discharge.
Pearson, 2020²⁸	Tanzania, HF: 6 tertiary hospitals	Postpartum women: 18 years or older, recruited after delivery and before discharge	ANC+: FIGO’s PPIUD intervention: Training of providers (to improve counseling), information leaflet provision, establishing video broadcast, training and supplies for PPIUD insertion, regular monitoring, and support.	Counseling occurred during routine ANC or after admission for delivery; provision of PPIUD in the immediate postpartum and before discharge.
Tran, 2019²⁹	Burkina Faso, lower-level HF: 8 PHCs	Pregnant women: third trimester, attended ANC at study centers	ANC+: 3 facility-oriented interventions (i.e., refresher training of service providers, regularly scheduled and strengthened supportive supervision of providers, enhanced availability of services 7 days a week), and 3 individual-based interventions (i.e., a PPFP counseling tool, appointment cards for women, and invitation letters for partners).	Individual-based interventions delivered during third-trimester ANC visits and postnatal care follow-up visits.
Tran, 2020³⁰	DRC, lower-level HF: 8 PHCs	Pregnant women: third trimester, attended ANC at study centers	ANC+: 3 facility-oriented interventions (i.e., refresher training of service providers, regularly scheduled and strengthened supportive supervision of providers, enhanced availability of services 7 days a week), and 3 individual-based interventions (i.e., a PPFP counseling tool, appointment cards for women, and invitation letters for partners).	Individual-based interventions delivered during third-trimester ANC visits and postnatal care follow-up visits.
Jarvis, 2018³⁷	DRC, HF, mixed levels: 2 hospitals, 2 maternity referral centers	Pregnant and postpartum women aged 18–49 years, gestational age not specified, exiting services at study hospitals (L&D, FP, ANC, PNC, child immunization)	ANC+: In-person whole-site training for providers on quality inputs: clinical training and provision of equipment for PPIUD, training on WHO’s Medical Eligibility Criteria for Contraceptive Use, and introduction of a systematic screening and referral tool for FP (to be implemented by ANC, PNC, immunization, labor and delivery, and FP providers). Free contraceptives provided by labor and delivery and FP units.	7-day training
Karra, 2022⁴⁴	Malawi, community: 1 city, recruited through household visits	Pregnant and postpartum women aged 18–35 years currently pregnant or up to 6m postpartum	ANC+: FP information package and private individual counseling visits: risk assessment for clinical methods and detailed information on methods switching, side effects associated with each method, benefits of contraception, birth spacing, dual protection, and male partner involvement. Financial: free transportation (taxi) service to a designated high-quality FP clinic with low waiting times; Free FP services at designated clinic or financial reimbursement for any FP services received at other clinics; and reimbursement for treatment costs if woman experienced any contraindications or side effects related to use of FP. Free phone consultations to discuss side effects if needed.	1 counseling session within 1 month after administering baseline, 5 shorter follow-up sessions spaced over 2 years; sessions lasted up to 1 hour.
Espey, 2021⁴⁵	Rwanda, HF, mixed levels: 2 high-volume hospitals, 4 health centers	Pregnant and postpartum women (up to 6 weeks postpartum)	ANC+: Group and individual counseling to expectant mothers (with possibility of partner involvement) on PPFP, integration of FP counseling in ANC, labor and delivery, and infant vaccination services. Provider training on PPIUD insertion/removal. Higher provider reimbursement for IUDs compared to implants. Engagement with Ministry of Health stakeholder.	Antenatal period up to 6 weeks postpartum. Group sessions and individual counseling lasted 20 minutes each.
Wu, 2020⁵¹	Nepal, community: 1 rural municipality	Postpartum women: married, aged 15–49 years, up to 1 year postpartum	ANC+: In-person home-based ANC and PNC counseling by CHW on clinical topics included recommendations and reasons for birth spacing, contraceptive efficacy, contraindications, timing for initiation of PPFP, and facilities where each method; training materials emphasized best practices for contraceptive counseling, such as shared decision-making, respect for patient autonomy, and anticipatory guidance on potential side effects, and home-based childcare and counseling.	General contraceptive counseling occurred at the eighth month ANC home visit, and patient-centered contraceptive counseling was offered at PNC months 1, 5, and 10.
Ahmed, 2015⁵³	Bangladesh, community: 4 rural unions	Pregnant women: gestational age not specified (recruitment must have happened <32 weeks)	ANC+: CHWs discussed the importance of pregnancy spacing, effective LAM use, and LAM transition (+ flyers summarizing information). In addition, CHWs provided oral contraceptives, condoms, and injectables. Community-based monthly meetings to discuss importance of pregnancy spacing and PPFP, including LAM.	Household visits every 2 months (antenatal and postnatal period; pregnancy-surveillance visits) and community-based meetings every month.
Cooper, 2016⁵⁶	Egypt, community: households, 6 governorates	Postpartum women: women with a child aged 24 months or younger	ANC only: Home visits and community-based group discussion counseling covered benefits of FP, healthy timing and spacing of pregnancies, postpartum return to fecundity, and risk of pregnancy after childbirth, LAM, and gender roles. Mobile clinics offered free medical care, including FP. Cooperation with health directors and pharmacists to improve access to FP methods.	During pregnancy and up to 24 months postpartum
Systems strengthening
Buser, 2021⁴⁷	Zambia, lower-level HF: 40 HFs	Postpartum women aged 15 years or older, women who gave birth in one of the study facilities in the previous 13m	ANC+: Improving MWHs through infrastructure, equipment, and supplies to address the need for higher quality, safer MWHs; policies, management, and financial structures; and linkages to health systems with skilled midwives (incl. participation of women living in MWH in maternal and child education courses at HF)	Around births (women in MWH could attend ANC and PNC)
Maru, 2017⁴⁹	Nepal, mixed HF and community: hospital and community (CHWs in 14 community clusters)	Pregnant women aged 15–49 years, gestational age not specified	Unclear: Evaluated improvements to existing public-private partnership program: strengthening CHW active surveillance, integrating digital health information, and increasing monitoring and supervision capabilities. CHWs continuously survey population for new pregnancies, assist in attaining laboratory and ultrasound testing to identify high-risk pregnancies, and follow those pregnancies through postpartum period. Patient data are collected in an open-source electronic health records platform, and key performance measures are tracked and incorporated into the financial contract.	Not specified
Training intervention
Providers
Dhital, 2021⁵⁰	Nepal, Mixed, HF and community: 2 major referral hospitals and catchment area of 23 peripheral HFs	Female community health volunteers and postpartum women	ANC only: Training for providers covered different PPFP methods and advantages and disadvantages of each and PPIUD in more detail as it was only long-acting reversible method available in immediate postpartum period in Nepal.	Not specified

Abbreviations: ANC, antenatal care; ANC+, antenatal period and other periods; CHW, community health worker; DRC, Democratic Republic of the Congo; EBF, exclusive breastfeeding; FIGO, Federation of International Gynaecology and Obstetrics; FP, family planning; HF, health facility; IUD, intrauterine device; LAM, lactational amenorrhea method; MCH, maternal and child health; MWH, maternity waiting home; PHC, primary health center; PNC, postnatal care; PPFP, postpartum family planning; PPIUD, postpartum intrauterine device; SMS, short messages service; WHO, World Health Organization.