Birth spacing and informed family planning choices after childbirth in Burkina Faso and the Democratic Republic of Congo: Participatory action research to design and evaluate a decision-making tool for providers and their clients

•Postpartum family planning (PPFP) is essential for maternal and newborn health.•It is not systematically addressed before or after childbirth.•Participatory action research is key to research and address this sensitive issue.•A PPFP counseling tool can guide a systematic discussion on birth spacing options. Postpartum family planning (PPFP) is essential for maternal and newborn health but is often not systematically addressed before or after childbirth. This article describes the development and field-testing of a PPFP counseling tool to support providers and women. Participatory action research involving women, men, providers, policymakers, researchers, and contraceptive experts from Burkina Faso and the Democratic Republic of Congo. The tool consists of an A4-size flipchart with illustrations on the client side and clinical information and counseling tips on the provider side, and can be used during visits of the antenatal-delivery-postnatal care continuum. Qualitative results suggest that the tool is easily understandable, user-friendly, relevant, and useful with regard to providing PPFP information to clients, and respectful of clients’ rights and choices. It may have a positive influence on clients’ attitudes towards PPFP and their decision to use contraception. The tool holds promise in guiding a systematic discussion on birth spacing options among providers and clients. Its impact on contraceptive uptake requires further research. If proven effective, the tool could be disseminated to Ministries of Health and local, regional, and global partners to strengthen national family planning and maternal and child health strategies in low-resource countries.