J Fam Plann Reprod Health Care. 2016 Apr;42(2):93-8

Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals

Heller R, Cameron S, Briggs R, Forson N and Glasier A

Abstract

Background: Women in the postpartum period need effective contraception. Unintended pregnancies soon after childbirth may lead to abortion or short inter-pregnancy intervals associated with adverse outcomes. Using databases for a 6-month period (September 2013-February 2014) we examined the proportion of women attending for abortion in Edinburgh, Scotland who had given birth in the preceding 12 months, and the proportion of women giving birth in this region after an inter-pregnancy interval of 12 months or less. We also surveyed 250 women prior to discharge from the same maternity service about their contraceptive intentions.

Results: Some 75/1175 (6.4%) attending for abortion had given birth within the preceding 12 months and 332/4713 (7.0%) postpartum women gave birth following an inter-pregnancy interval of 12 months or less. When considering parous women, percentages were 13.3% and 13.9%, respectively. The majority (n=237, 96.7%) of postpartum women were not planning another pregnancy within the year but only a minority (n=32, 12.8%) were planning on using long-acting reversible contraception (LARC), namely the implant or intrauterine device. However, 42.8% (n=107) indicated that if the implant or intrauterine contraception could be inserted before they left hospital then they would choose these methods (p<0.0001).

Discussion: Almost one in thirteen women in our population presenting for abortion or giving birth has conceived within 1 year of giving birth. Provision of LARC immediately postpartum appears to be an attractive option to mothers, and could be an important strategy to prevent unintended pregnancy and short inter-pregnancy intervals.

Comment: This study had an unusual approach of looking at short birth intervals: the authors studied women coming for abortion within a year after giving birth. Like the previous abstract this one shows how important it is 1) to discuss postpartum contraception during prenatal visits; and 2) to offer LARC immediately after delivery in the form of an IUD and/or a progestin-only method. (HMV)