# Birth Control to Improve Birth Spacing (BIBS): a Prospective Longitudinal Cohort Study

> **NIH NIH R21** · BRIGHAM AND WOMEN'S HOSPITAL · 2022 · $227,679

## Abstract

Project Summary/Abstract
Because most people return to sexual activity shortly after giving birth, consistent use of effective contraception
is critical to achieving healthy birth spacing. Healthy birth spacing could be dramatically improved at the
population level by increasing the proportion of postpartum patients who receive and continue use of very
effective contraceptive methods (including any method with less than a 10% typical use failure rate) after birth.
However, data are lacking regarding what knowledge and attitudinal factors drive pregnant people’s intention
to use contraception after birth. Additionally, not all individuals who form an intention to use contraception
postpartum end up being able to act on that intention after birth. It is unknown what specific environmental
barriers prevent patients from receiving desired contraception postpartum. This study will fill the evidence gap
around drivers of postpartum contraceptive use by achieving the following aims: Aim 1: Clarify the role of
contraceptive knowledge, attitudes, norms, and self-efficacy in driving intention to initiate very effective
contraception (VEC) postpartum. We will enroll pregnant patients at two large academic medical centers with
medically and demographically diverse patients, and query them through a baseline survey regarding factors
that influence intention to use contraception postpartum. Aim 2: Describe the impact of environmental barriers
on enacting intended postpartum VEC initiation. Using a sequential mix-methods design, we will explore how
the effect of intention on actual postpartum VEC initiation varies by environmental factors. Quantitative data will
be collected from an electronic medical record review and a 12-week postpartum patient survey, and
qualitative data through interviews of select participants who faced significant barriers in attempting to initiate
postpartum contraception. We will conduct formal statistical tests of effect modification to quantify how
environmental factors modify the effect of planned VEC initiation on actual initiation. Qualitative interviews will
additionally explore the processes through which patients experience, interpret, and respond to environmental
barriers. This study is innovative because of its novel grounding in behavioral theory, prospective design
enabling testing of hypothesized behavioral-environmental drivers of outcomes, and mixed-methods approach
to developing future interventions to improve population health by increasing healthy birth spacing. This project
will be impactful because findings will lead directly to development of 1) an evidence-based approach to
antenatal counseling about postpartum contraception that will increase intention to use VEC, and 2)
recommendations for interventions at the health system level to ameliorate structural barriers that impede
postpartum patients’ ability to act on that intention. Results will be disseminated to lay community health
advocates and clinical leaders...

## Key facts

- **NIH application ID:** 10452665
- **Project number:** 5R21HD103977-02
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Elizabeth Janiak
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $227,679
- **Award type:** 5
- **Project period:** 2021-07-15 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10452665

## Citation

> US National Institutes of Health, RePORTER application 10452665, Birth Control to Improve Birth Spacing (BIBS): a Prospective Longitudinal Cohort Study (5R21HD103977-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10452665. Licensed CC0.

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