BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION THE CASE FOR CHANGE
“The initial set up of the service was very difficult and it is equally difficult to maintain and expand it. It took us over a year of negotiations with Sexual Health and our finance department to get the funding for coils and implants in place.” The 6-week Postpartum Check with a GP Moreover, many contributors outlined how the inconsistency and absence of PPC provision antenatally and in the immediate postnatal period means that currently avoidable pressure was being placed on GPs at the 6-week postpartum check. Echoing this, an online survey of UK mothers reported that for over half of the respondents, the 6-week GP postpartum visit was the first time contraception was properly discussed. 46 Indeed, GPs have long reported the pressures and competing priorities of the postnatal visit, as well as the need for additional appointments to provide LARC. 47
Across the country, there are several examples of impressive progress which has been made to establish comprehensive PPC offers to women locally: For example, in Gloucestershire: “The [PPC] pilot revealed that 68% of pregnancies among the target population (women with vulnerabilities) were unplanned. Results [from this pilot] demonstrated that 90% of women discussed contraception with their midwife, 89% made a contraception plan antenatally, and 76% received their preferred method prior to discharge... Over 94.7% women received contraceptive counselling post-birth.” In Liverpool, data from the first year of their PPC service showed:
STAFF TRAINED TO FIT AND COUNSEL 8
7
FURTHER STAFF IN TRAINING
Maternity Journey
IMPLANTS FITTED YEAR 1 97
RECEIVED PROGESTOGEN- ONLY PILL 101
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6
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7
In Bedfordshire: “One of our trusts has operationalised the pathways, and contraception is now available to mothers attending this unit for maternity care. All mothers are offered a fitting during the time of caesarean section. To date we know 80 IUDs have been inserted post-caesarean section.” This is due to the dedication, skills and commitment of local healthcare professionals who have overcome significant barriers and won the ‘hearts and minds’ of colleagues to establish services for local women. 45 For example, in Bradford and Craven: “We learned that change takes more than clinical protocols; it takes cultural transformation. When the Progesterone Only Pill (POP) was delivered by pharmacy to the Birth Centre, it was returned by the staff, stating they do not dispense this medicine.” In addition to regional variation in PPC services, what was also evident from the contributions to the report was how many now successful PPC services had struggled to set up services initially, facing bureaucracy and operational barriers. For example, in South Tees:
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8
9
1
0 months
‘10 appointments during pregnancy = 10 opportunities to discuss and normalise contraception after pregnancy
45 These professionals include Vicki Pirie, Lead Contraception Midwife in Gloucestershire, James Woolgar, Chair of English HIV and Sexual Health Commissioners’ Group (EHSHCG), Gillian Matthews, Specialist Midwife in London and Frances Lamb, Consultant Obstetrician in South Tees.
46 Mumsnet, Mumsnet/BPAS survey shows gaps in contraception care for new mums – unclear advice to breastfeeding women raises risk of unplanned pregnancy (2012) . 47 Lunniss H, Cameron S, Chen ZE. Views of general practitioners on providing contraceptive advice and long-acting reversible contraception at the 6-week postnatal visit: a qualitative study. J Fam Plann Reprod Health Care 2016; 42:99–106.
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