PROJECT SUMMARY The World Health Organization recommends postpartum family planning (PPFP) for birth spacing and prevention of maternal and newborn morbidity and mortality. Unfortunately, unmet need for PPFP remains extremely high across developing countries, including Zambia. PPFP services have not been routinely implemented in Zambia due to lack of stakeholder involvement, limited provider training, lack of demand- creation strategies informed by client needs and preferences, and lack of optimized operational procedures. Additionally, the role of male involvement in PPFP uptake is critical and widely overlooked. To address these issues, we will undertake the necessary formative work to develop and pilot test an innovative, evidence-based intervention to improve PPFP services in Zambia. We will first conduct in-depth interviews with key stakeholders and focus groups with government facility nurses to evaluate structural- and contextual-level factors that influence the achievement of healthy birth intervals (Aim 1). We will also assess facility organizational readiness to implement PPFP services via direct observation of practices and operational workflows. We will then conduct focus groups with pregnant women and couples to evaluate individual- and couple-level factors that influence the achievement of healthy birth intervals (Aim 2). Finally, based on stakeholder, provider, and couple/client preferences and needs, we will develop and pilot test PPFP training and promotional tools, workflows, and identify and engage PPFP champions (Aim 3). This is the first study to rigorously develop PPFP demand creation and service implementation strategies in Zambia. With the renewed interest in PPFP services from the Zambian Ministry of Health, this proposal is extremely well-timed and has the potential to make a significant impact on PPFP services to improve birth spacing, reduce abortion, and reduce maternal-child morbidity and mortality. Moreover, our PPFP intervention is a potentially replicable and sustainable model that could be expanded to other sub-Saharan African countries.