BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION A GUIDE FOR BEST PRACTICE
PPC in Scotland and Wales
A View from Wales Similarly, Wales are also implementing PPC as part of the NHS Wales Women’s Health Plan. In December 2024 the first Women’s Health Plan for Wales was published outlining a ten-year vision (2025-2035) for delivery of women’s healthcare. 45 This ambitious plan outlines how women’s health will be delivered across eight priority areas, including post-pregnancy contraception. The need for timely engagement on PPC has been further emphasised in ‘Maternity Care in Wales; A Five-Year Vision for the Future (2019-2024) which commits to both pre-pregnancy counselling and post-pregnancy contraception advice and administration. 46 Discussions are underway for a ‘Once for Wales’ approach to training in PPC and how this might be delivered. This is a strategy focused on standardisation, coordination and shared learning across different areas of the health system. Collecting data on this, however, is challenging, as local health boards collect and record information in different ways. An action from the NHS Wales Women’s Health Plan is to establish a national database of key measurables on women’s health, and provision of contraception including PPC. Efforts to improve access to education and training are also vitally important, with plans to review workforce capacity and competencies to ensure there are enough appropriately trained staff to deliver LARC across primary care, within specialist abortion services and in obstetrics and gynaecology departments.
In producing this report, we also have learnt from PPC provision in Scotland and Wales who are pioneering approaches that may be replicated beyond national borders. Northern Ireland also has an active PPC service in Belfast. A View from Scotland Scotland have been leading the way in terms of best practice of PPC. The Women’s Health Plan for Scotland (2021-2024) included a specific priority to: “Ensure that discussions on contraception take place during pregnancy. Women should be given adequate and appropriate information on their options, as well as rapid access to their preferred method where applicable to ensure rapid and easily accessible postnatal contraception as a priority.” 40 Although much progress has been made in Scotland to try to achieve this end, there is still work to do, particularly in ensuring access to immediate postpartum LARC: “Postpartum contraception will continue to be a priority in the next phase of the Women’s Health Plan to be published in 2025.” Much of the UK’s early research demonstrating the need for and feasibility of PPC provision was conducted in the Lothian region of Scotland. 41 Early studies showed that women valued the opportunity to discuss contraception during pregnancy with their midwife or obstetrician. 42 This led to routine antenatal contraception discussions and the introduction of midwife contraceptive ‘champions’, with specialist knowledge and skills in contraceptive provision being embedded into routine care within the region. 43 Later research demonstrated the safety and feasibility of immediate postpartum implant and IUD insertion. 44 Many of these novel approaches to PPC service provision have influenced national policy direction in Scotland and are increasingly being adopted into routine care in other health Boards. The national approach to improving PPC access has been aided by the Scottish PPC Network, which was established at the end of 2021 to connect stakeholders involved in regional PPC delivery and support shared learning. The network itself comprises multidisciplinary healthcare professionals including midwifery, obstetrics, sexual health, pharmacy, public health and clinical researchers, with representatives from all the 14 Scottish Board areas. The network had several successes, including an early aim of simplifying access to training and education for maternity staff and reducing regional inconsistencies in PPC delivery. In 2023, the Scottish Government funded a three-year project, facilitated by the network to improve PPC training, implementation and patient information across Scotland. 40 Scottish Government, Women’s Health Plan. 41 Cooper M, Cameron S. Successful implementation of immediate postpartum intrauterine contraception services in Edinburgh and framework for wider dissemination. International Journal of Gynaecology & Obstetrics. 2018 Sep; 143:56-61. 42 Cameron ST, Craig A, Sim J et al. Feasability and acceptability of introducing routine antenatal contraceptive counselling and provision of contraception after delivery: the APPLES pilot evaluation. BJOG: An International Journal of Obstetrics & Gynaecology. 2017 Dec; 124:2009-15. Gallimore A, Irsha T, Cooper M, Cameron S. Influence of culture, religion and experience on the decision of Pakistani women in Lothian, Scotland to use postnatal contraception: a qualitative study. BMJ Sexual & Reproductive Health. 2021 Jan; 47:43-8. 43 Gallimore A, Craig A, Cameron S, et al. Developing the role of midwives as ‘Contraceptive Champions’ to support early access to effective postnatal contraception for women. BMJ Sexual & Reproductive Health 2019; 45:309-312.
44 Croan L, Craig A, Scott L, et al. Increasing access to contraceptive implants in the postnatal period via a home insertion service by community midwives. BMJ Sex Reprod Health. 2018 Jan; 44(1):61-64; Heller R, Johnstone A, Cameron ST. Routine provision of intrauterine contraception at elective cesarean section in a national public health service: a service evaluation. Acta Obstet Gynecol Scand. 2017 Sep;96(9):1144-1151; Cooper M, McGeechan K, Glasier A, et al. Provision of immediate postpartum intrauterine contraception after vaginal birth within a public maternity setting: Health services research evaluation. Acta Obstet Gynecol Scand. 2020 May; 99(5):598-607; Cooper M, Boydell N, Heller R, Cameron S. Community sexual health providers’ views on immediate postpartum provision of intrauterine contraception. BMJ Sex Reprod Health. 2018 Apr; 44(2):97-102; Boydell N, Cooper M, Cameron ST, Glasier A, et al. Women’s experiences of accessing postpartum intrauterine contraception in a public maternity setting: a qualitative service evalutation. Eur J Contracept Reprod Health Care. 2020 Dec; 25(6)465-473. 45 The Women’s Health Plan for Wales, NHS Wales Executive. 46 Welsh Government, Maternity Care in Wales - A Five-Year Vision for the Future (2019-2024).
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