By Dr Janet Barter and Prof Ranee Thakar Introduction
Fertility also returns quickly after an abortion, with ovulation occurring as soon as 8 to 10 days and typically within three weeks of the procedure, regardless of the method of abortion. 14 Additionally, more than half of women resume sexual activity within two weeks of a termination of pregnancy. 15 A UK study reported that almost 1 in 13 women presenting for an abortion or birth had conceived within a year of a previous birth, and 1 in 8 women with children conceive and continue another pregnancy within the same time frame. 16 Without access to timely information and a method of choice, women may be at risk of an unplanned pregnancy soon after birth, abortion, or baby loss. Post-pregnancy contraception refers to the methods used to plan and prevent pregnancy after childbirth, and crucially after miscarriage, pregnancy loss, abortion, ectopic pregnancy, or gestational trophoblastic disease. It is integral to supporting women to have all necessary information and informed choice of methods no matter the pregnancy outcome. Importantly, the experiences of bereaved mothers must also be considered in this discussion. Miscarriage is the most common adverse pregnancy outcome with estimates rates of 10-15% in the UK. The NHS advises women that they “will need to use contraception from day 5 after a miscarriage or ectopic pregnancy” if they do not wish to conceive immediately. 17 Yet, it is rare for units managing early pregnancy loss to be able to provide this contraception. 18 Additionally, improved provision of PPC helps to tackle common myths and misconceptions around women, pregnancy, contraception, and fertility. For example, providers of PPC in Greater Manchester (Manchester, Trafford and Salford (SSCMS)) found that in asking women on the postnatal ward when they thought they could get pregnant again after birth, answers varied from “straight away” to “150 days” to “2 years.” 19 National statistics support this need for improved access to accurate knowledge and counselling on contraception. It is therefore crucial that women are able to make informed choices about contraception and access the support they need post-pregnancy. We also know that this is what women want. One study of women on postnatal wards found nearly 97% of the women stated that they were not planning a baby in the next year. 20 Furthermore, providing PPC offers a significant opportunity to reduce health inequalities by enabling access to contraception for women who may not engage with sexual health services. Yet, despite these opportunities and demand for PPC, too many health services are not set up to facilitate this, and women face a postcode lottery of provision across England. We strongly welcome the recognition of the importance of PPC in the Women’s Health Strategy and the opportunity the strategy presents to adopt a life-course approach to women’s health: “Information about contraception after childbirth should be offered in the antenatal period to support informed decision-making.
As Presidents of the College of Sexual and Reproductive Health and Royal College of Obstetricians and Gynaecologists (RCOG) we are deeply committed to ensuring every woman has access to contraception and can make informed choices about when and if to have a child. This is fundamental for women to be able to live well and pursue ambitions in every aspect of their lives. Today, women across the UK are becoming sexually active earlier and are having children later in comparison to previous generations. With a preference for having fewer children, women now spend decades of their reproductive life trying to prevent or plan pregnancy. However, despite this, we also know from our own experience as clinicians and from the thousands of members delivering front-line services across the UK that we represent, that too many women still face obstacles in accessing the contraception they need. In Britain, it is estimated that around 45% of pregnancies are unplanned or ambivalent, 10 abortion statistics are at a record high, with the latest data recording a 17% increase in procedures in comparison to the previous year. 11 Data also shows that more than half of women accessing abortion care have children, and 41% have had one or more previous abortions. 12 We firmly believe that abortion is an essential component of healthcare and a vital aspect of women’s reproductive rights and autonomy. Yet, these statistics suggest an unmet need for effective contraception, including after pregnancy. The Importance of Access to Post-Pregnancy Contraception (PPC) Pregnancy is a significant reproductive event during which women are in regular contact with healthcare services, creating an opportunity to discuss contraceptive choice with women and their partners and to provide contraception to help them plan or avoid future pregnancies. Fertility returns soon after pregnancy, as early as three weeks after birth, even before the return of menstruation. 13
10 The National Survey of Sexual Attitudes and Lifestyles (Natsal-3). 11 Office for Health Improvement and Disparities. Abortion statistics for England and Wales: 2022 12 Office for Health Improvement and Disparities. Abortion statistics for England and Wales: 2022 13 NHS.uk. Sex and contraception after birth. 14 Boyd EF, Jr, Holmstrom EG. Ovulation following therapeutic abortion. Am J Obstet Gynecol. 1972;113:469–473. Lähteenmäki P, Luukkainen T. Return of ovarian function after
abortion. Clin Endocrinol (Oxf) 1978; 8: 123–32. Schreiber CA, Sober S, Ratcliffe S, Creinin MD. Ovulation resumption after medical abortion with mifepristone and misoprostol. Contraception 2011; 84: 230–3. 15 Boesen HC, Rørbye C, Nørgaard M, Nilas L. Sexual behavior during the first eight weeks after legal termination of pregnancy. Acta Obstet Gynecol Scand. 2004 Dec;83(12):1189–92. 16 Heller R, Cameron S, Briggs R, et al. Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals. J Fam Plann Reprod
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