BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION A GUIDE FOR BEST PRACTICE
Recommendation 4 Foster Collaboration and Support for PPC Across Disciplines Collaboration with colleagues across the pregnancy/ maternity journey is essential, including obstetricians, GPs, SRH professionals, sexual health services, health visitors, and community pharmacy. Establishing clear pathways to public health initiatives will strengthen services locally. flexible approach to coverage of PPC is recommended. Establishing these pathways as early as possible with a collaborative and integrated
A prominent theme which emerged from Dr Rebecca Mawson’s focus groups held with marginalised women in Sheffield was the inappropriateness of the timing of first contraception discussions after childbirth. Many women expressed that these conversations were poorly timed and insensitive to their physical and emotional state: “For many women, the first time they learned anything about contraception was in the postnatal period. They married and then had a baby, not requiring contraception discussions before that time.” Dr Rebecca Mawson, Sheffield This feedback about the importance of antenatal contraceptive counselling was not unique to women in Sheffield and is supported by both feedback from providers of PPC to this report and existing academic research: “People don’t want to listen to it because they are in a bay full of other women so it’s the last thing on their minds and they have got like a baby that’s crying and not slept in so many hours so it’s not a lot that goes through … they are so tired … they forget everything.” 35 Community Midwife, Edinburgh “Midwives who offer PPC counselling during antenatal visits create a foundation for informed choice, reducing anxiety and decision-making pressure in the immediate Contributors to the report outlined that when contraception is only raised in the post-pregnancy period, it can feel like an afterthought, undermining its importance in postpartum care. Instead, by raising it in the antenatal period, it is presented as a valuable part of the overall care process. To streamline the patient journey, the South Tees PPC service recommends including a dedicated section in pregnancy notes to record contraception discussions and the woman’s choices. This would provide clear visibility for hospital midwives, enabling them to ensure contraception is provided before discharge— without placing the burden on the woman to request it. This best practice is also found in Gloucestershire where they map the key touchpoints of the maternity journey, where information can be shared, and decisions noted: postnatal period.” Midwife, Gloucestershire
5. The Importance of Contraceptive Counselling During Pregnancy 5
“It can easily be integrated into antenatal and postnatal discussions—women are generally very open to it when it’s brought up early.” Midwife, Gloucestershire The timing of discussing contraception with women and their birthing partners emerged as a key lesson from many PPC providers. This was also a key finding that emerged from analysis of the 2023 Women’s Reproductive Health Survey, which highlights the need for high-quality contraceptive counselling as part of maternity care, with counselling during or immediately after pregnancy positively impacting contraceptive initiation and use. 34 Overall, contributors were in consensus that making contraception discussions a routine part of care during pregnancy was key to increasing uptake after birth and crucially this information must be flexibly personalised to their experiences, needs, and wishes.
34 C. Stewart, A. Hough, M. J. Palmer, O. McCarthy, R. S. French, and N. Pathak, “Factors Associated With Contraceptive Initiation and Use Among Women Who Have Given Birth in the Last Year: Findings From the 2023 Women’s Reproductive Health Survey,” BJOG: An International Journal of Obstetrics & Gynaecology (2025): 1–11.
35 McCance K, Cameron S. Midwives’ experiences and views of giving postpartum contraceptive advice and providing long-acting reversible contraception: a qualitative study, J Fam Plann Reprod Health Care 2014;40:177–183.
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