“We did awareness session with health visiting leads around existing pathways and signposting women to the existing community based sexual and reproductive health services where postnatal contraception is required. This pathway is well utilised for women who have comorbidities and vulnerabilities.” Commissioner, Bedfordshire, Luton and Milton Keynes ICB This is backed up by research by Gilroy et al. which showed that health visitors can play a vital role in providing PPC postnatally in the community and that interpregnancy care is a core part of the health visiting offer. 32 Following this, a bespoke training package on postnatal contraception was designed and developed for health visitors. Since its launch in March 2022, these tailored training resources has been delivered to over 80 health visitors and midwives and are available to read in the resources section of this report. “The statistics made it really hit home and made me realise how important it was as part of my role” 33 Health Visitor quoted in Gilroy et al. Contributors outlined specifically how collaboration with SRH professionals was essential to successfully deliver contraceptive provision post-pregnancy. For example, in Liverpool, the PPC service collaborated with a local sexual health provider - Axess Sexual Health. Axess plays an important role in supporting the delivery of PPC through its expertise in sexual and reproductive health, and providing additional resources and services, to ensure that women have continued support in accessing contraception post-pregnancy. A pathway for Intrauterine Devices (IUD) check in the Axess Specialist Integrated Urgent Care clinic at 6 weeks post insertion at caesarean has been established and early evaluation shows it to be working well. Similarly, in Greater Manchester: “Strengthening links with primary care, sexual health, and gynaecology services would ensure smoother continuity of care and clearer referral pathways to access wider services.” PPC provider, Greater Manchester In South Tees, clear referral pathways with the local sexual health services proved vital to providing women with the contraception they wanted, when worked for them, for example after leaving the hospital ward:
“If we are unable to provide the right contraception to women prior to discharge or, if women would prefer to wait for LARC or, for women who require specialised input regarding contraception we have worked together with our local sexual health services to create a referral form. We refer these women directly and they are then fast tracked into their local service.” Public Health Midwife, South Tees Overall, contributors stressed the need for this integration with other health or community services, and how establishing these robust care pathways should be a priority and must be set up as early as possible. Similarly, this emphasis on collaboration and integration is also important to facilitate women accessing wider public health services in their local community. For example, in Portsmouth, women could be referred through their PPC service to sheltered housing, substance misuse services or Project W for women who experience substance misuse and/or homelessness. The service has also worked with the weight management and stop smoking teams working with pregnant people to support these healthy conversations and access to information. In Cambridge an approach was piloted by the team at the antenatal diabetes clinic within Cambridge Community Trust: “Women are offered contraception discussions around at 20–24 weeks of their pregnancy. Many of these women, who often require planned caesarean sections around 38 weeks, found it helpful to plan their contraception in advance.” PPC provider, Cambridge Community Trust Examples of best practice such as these demonstrate the value and potential of PPC services to deliver better outcomes for the health of the mother and child, alleviate wider public health concerns, and improve health literacy of the population. Importantly, given that ICB geography doesn’t match that of a local authority,
32 Gilroy V, Gilmore KL, Thwaites A. Better way of working, Exploring and promoting the role of health visitors in postnatal contraception: a ‘test and learn’ project, BMJ Sex Reprod Health 2023;49:219–221.
33 Gilroy V, Gilmore KL, Thwaites A. Better way of working, Exploring and promoting the role of health visitors in postnatal contraception: a ‘test and learn’ project, BMJ Sex Reprod Health 2023;49:219–221.
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