“In one instance, a 15-year-old planned to have an implant fitted postnatally but was too distressed on the ward due to a transfer to a mother-and-baby foster placement. A follow-up home visit enabled timely contraception.” “Another woman with learning difficulties was supported over multiple appointments using simplified resources, while a mother with mental health challenges accessed a virtual consultation and felt empowered by the process.” Quotes from Gloucestershire PPC service “By embedding contraception provision into routine maternity care, the service ensures women are supported with timely, effective options that align with their needs and circumstances, ultimately promoting reproductive autonomy and reducing health inequalities across Greater Manchester.” Greater Manchester PPC service
“Women from Black and ethnic minority backgrounds and lower socioeconomic groups are at greater risk of physical and psychiatric conditions of pregnancy when compared to white British women. Without appropriate education about risk factors, such as obesity and smoking, as well as effective and robust mechanisms for follow-up beyond the traditional postpartum period of 6 weeks, these inequalities are reinforced.” Commissioner, Bedfordshire, Luton and Milton Keynes ICB Contributors agreed that providing PPC helps to address wider public health inequalities and improve health outcomes for mothers in the most deprived areas while they are already in contact with health service. This echoes academic research into PPC: “Our [research] results also highlight the potential for contraception provision on the postnatal ward to reduce inequalities in access to contraceptive services as 10% of our sample had never used any contraception.” Thwaites A, Logan L, Nardone A et al.’s study. 37 Importantly, echoing existing research, contributors were keen to stress that a universal approach to providing PPC was essential to tackling inequalities. Only by ensuring that all pregnant people and their partners, regardless of their background or circumstances, receive an offer of contraception can a service can address the needs of all vulnerable populations and reduce disparities. 38 PPC Can Provide Huge Cost-Benefits to the NHS: A strong argument in favour of improving the provision of PPC is its huge potential for cost-saving benefits to the NHS and wider health system. The cost of training and initial contraceptive supply is offset by public health and financial savings including on: • Reduced rates of unplanned and high-risk pregnancies • Decreased demand on primary care, abortion and maternity services • Prevention of complications associated with short birth intervals
37 Thwaites A, Logan L, Nardone A, et al. Immediate postnatal contraception: What women know and think BMJ Sex Reprod Health 2019;45:111–117. 38 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 Health Care 2016;42:93–8.
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