A digital tool to support pregnancy planning, preparation and prevention

"You're either on contraception or you're pregnant, and that middle step is missing". So said one woman in our qualitative research, describing the gap that we are attempting to fill. We are developing a digital tool to support people of reproductive age to understand their pregnancy preferences and to develop and implement a reproductive life plan; helping prevent unplanned pregnancies, improve pregnancy planning, preparations and outcomes, and reduce inequalities in maternal health.

Nearly half of all pregnancies in the UK are unplanned, and discussions around pregnancy planning are not routine in healthcare settings; this results in missed opportunities to optimise health before pregnancy. Currently, over nine out of ten women conceive with at least one modifiable risk factor; this is widely recognised to be a major contributor to maternal mortality and morbidity, and particularly to the inequalities in outcomes for black and minority ethnic groups.

Meanwhile, it has also become increasingly difficult to access contraception in the UK over the last few years which, when coupled with dissatisfaction and discontinuation of contraception, contributes to unplanned pregnancies, which are associated with increased risks of stillbirth, preterm birth, low birthweight, neonatal mortality and postnatal depression.

There is an unmet and expressed need among people of reproductive age for support to develop and meet their reproductive goals. Furthermore there is a gap in the market for a tool that can support people of reproductive age identify their fertility intentions and develop a reproductive life plan. Our app uniquely combines both pregnancy prevention and preparation needs, in one place.

Our extensive qualitative and quantitative research (>100 hours of interviews and survey data from >3000 people) has informed our decision to create a digital tool, while the content, look and feel of the app has been rigorously co-developed, meaning the whole tool is evidence-based and user centred.

We have already co-developed a minimum viable product of the app which guides users through a series of questions about their reproductive preferences. Our algorithm, based on the validated Desire to Avoid Pregnancy Scale and derived through extensive data analysis, accurately predicts the probability of pregnancy. We have digitised this algorithm, incorporated it into the app, and mapped it to the Fertility Intention Typology (FIT), creating a simple-to-use tool for users who are presented with their FIT, likelihood of pregnancy, and tailored advice (see Supporting data 1).

We plan to further develop this app by building in an interactive reproductive life plan, taking the user from simply identifying their preferences to taking actions to achieve them. The app will guide users through a dynamic pathway of questions and prompts; supporting the individual to reflect on their own reproductive goals. Their answers will shape the questions presented, encouraging deeper engagement.

Avatars will be used to improve usability and engagement, along with in-built optional to-do items and reminders to help users achieve their goals.

We will use the COM-B model of behaviour change to guide the development; this person-centred approach can increase autonomy and self-efficacy and will enable healthcare professionals to better support individuals to meet their aims. Once developed, we will pilot the app in relevant settings (including education and healthcare settings) to gain preliminary data. At project end we will have a fully co-developed app which will be ready for implementation.