BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION A GUIDE FOR BEST PRACTICE
Appendix 2: Setting Out the Evidence, Research and Data on Post- Pregnancy Contraception to Enable Women’s Reproductive Choices By Dr Annette Thwaites, Dr Edward Mullins, and Dr Patricia A. Lohr
Edward is a Clinical Associate Professor in Women’s health at Imperial and the Geroge Institute for Global Health. Prior to the pandemic, he led a regional consortium of obstetricians, midwives, SRH professionals, commissioners and public health professionals to Dr Edward Mullins, Clinical Associate Professor, Department of Metabolism, Digestion and Reproduction & The George Institute for Global Health, Imperial College London; Honorary Consultant O&G, St Mary’s Hospital, Paddington.
Annette is a Consultant in Sexual and Reproductive Health at Guy’s and St Thomas NHS Foundation Trust and an Honorary Research Fellow at the Institute for Women’s Health, University College London. Her research interests include postnatal contraception with her MD focussed on the contraceptive needs of women after IVF pregnancy. Dr Annette Thwaites , Consultant in Sexual and Reproductive Health & Honorary Research Fellow.
commission and implement a regional post-birth contraception service for Northwest London which has since 2020 delivered contraception education to over 120,000 women in pregnancy and doubled the capacity to fit sub-dermal implants in the region. As of 2025, this is recurrently funded by the NW London ICB. He supervises midwives and doctors in research into optimising post-birth contraception and has been involved in women’s health policy, working with the current and previous Chief Medical Officers for England, RCOG and the COSRH to describe and deliver on the maior areas of unmet need in women’s health in the UK.
Research, evidence and academic consensus is clear - PPC plays a critical role in protecting health and wellbeing by preventing unintended pregnancies and allowing sufficient time after childbirth, abortion or miscarriage for women to plan and prepare for another pregnancy if desired. Data suggests that up to a third of ongoing, term pregnancies are unplanned to some extent. 54 This figure is approximately 50% in women requiring miscarriage management and almost 90% in women requesting abortion. 55 Abortion figures in England and Wales are currently at their highest since records began, with 43% of women undergoing abortions having had previous abortions; a proportion which has steadily increased over the past 10 years. 56 Reasons for this trend are undeniably multifaceted and complex, but studies have shown that this group includes those of greater socio-economic vulnerability and emphasise the need not only for access to timely post-pregnancy contraception but individualised care and counselling to ensure contraception choice that is right for and acceptable to the woman. 57 Many unplanned pregnancies occur within the first few months after childbirth. A UK study found that almost one in 13 women requesting an abortion or giving birth conceive within one year of giving birth. 58 When considering only women who already had children, over one in eight conceived again within 1 year of their previous birth. 59 In a US study of women who had experienced a short interpregnancy interval, around three quarters reported that the pregnancy had been unintended at conception. 60 54 Lakha F, Glasier A. Unitended pregnancy and use of emergency contraception among a large cohort of women attending for antenatal care or abortion in Scotland. Lancet 2006; 368: 1782–7. 55 Roe AH, McAllister A, Sammel MD, Schreiber CA. Pregnancy intentions and contraceptive uptake after miscarriage. Contraception. 2020 Jun;101(6):427-431; Lakha F, Glasier A. Unintended pregnancy and use of emergency contraception among a large cohort of women attending for antenatal care or abortion in Scotland. Lancet 2006; 368: 1782–7. 56 Government UK. Abortion statistics for England and Wales 2021. 57 Purcell C, Riddell J, Brown A, Cameron ST, Melville C, Flett G, Bhushan Y, McDaid L. Women’s experiences of more than one termination of pregnancy within two years: a mixed-methods study. BJOG. 2017 Dec;124(13):1983-1992; 58 Heller R, Cameron S, Briggs R, Forson N, Glasier A. Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals. J Fam Plann Reprod Health Care. 2016 Apr;42(2):93-8.
Patricia leads research and innovation at BPAS, focusing on building the evidence base for comprehensive abortion care and policy frameworks that advance reproductive autonomy. She previously served as Medical Director (2007–2024), contributes to national and international clinical guidance on sexual and reproductive health, and is Co-Chair of the British Society of Abortion Care Providers. Dr Patricia A. Lohr, Director of Research and Innovation, British Pregnancy Advisory Service.
However, the majority of women when asked postnatally are not planning another pregnancy within a year. 61 Women can conceive again from having sex without effective contraception as early as 21 days after giving birth and 5 days post abortion or miscarriage making timely access to post- pregnancy contraception essential. 62
59 Heller R, Cameron S, Briggs R, Forson N, Glasier A. Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals. J Fam Plann Reprod Health Care. 2016 Apr;42(2):93-8. 60 Brunner Huber LR, Smith K, Sha W, et al. Factors associated with pregnancy intention among women who have experienced a short birth interval: findings from the 2009 to 2011 Mississippi; 2009 Tennessee Pregnancy Risk Assessment Monitoring System. Ann Epidemiol 2018; 28:372–376. 61 Heller R, Cameron S, Briggs R, Forson N, Glasier A. Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals. J Fam Plann Reprod Health Care. 2016 Apr;42(2):93-8. 62 Jackson E, Glasier A. Return of ovulation and menses in postpartum nonlactating women: a systematic review. Obstet Gynecol 2011; CoSRH Guideline: Contraception After Pregnancy.
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