By Dr Janet Barter and Prof Ranee Thakar Introduction
We firmly believe that abortion is an essential aspect of healthcare and women’s reproductive autonomy. Yet, these statistics suggest an unmet need for effective contraception, including just after a 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 to avoid future unintended pregnancies. 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 (PPC) refers to the methods used to plan and prevent pregnancy after childbirth, and crucially after miscarriage, 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.
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 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 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, 11 Abortion statistics are at a record high, with the latest data recording a 17% increase in procedures in comparison to the previous year. 12 Data also shows that more than half of women accessing abortion care have children, and 41% have had one or more previous abortions. 13
Fertility returns soon after pregnancy, as early as three weeks after birth, even before the return of menstruation. 14 Additionally, more than half of women resume sexual activity within two weeks of a termination of pregnancy. 15
11 The National Survey of Sexual Attitudes and Lifestyles (Natsal-3). 12 Office for Health Improvement and Disparities. Abortion statistics for England and Wales: 2022. 13 Office for Health Improvement and Disparities. Abortion statistics for England and Wales: 2022. 14 NHS.uk. Sex and contraception after birth.
15 Boesen HC, RØrbye C, NØrgaard M and Nilas L, Sexual behaviour during the first eight weeks after legal termination of pregnancy; Acta Obstetricia et Gynecologica Scandinavica, 83: 1189-1192. 16 Heller R, Cameron S, Briggs R, et al. Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short-inter pregnancy intervals. Journal of Family Planning and Reproductive Health Care 2016;42:93-98.
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