offer of contraceptive counselling at the time of abortion and take up a method. 70 Studies from the Unites States have also demonstrated that women presenting for care for miscarriage are receptive to contraceptive counselling and 40% have been seen to take up offers of contraception. 71 Regardless of the outcome of their pregnancy, healthcare setting, or provider, all pregnant women should receive the highest standard of contraceptive care. 72 The pre- and post-pregnancy periods also present unique opportunities to reach those most vulnerable in society, who do not access or engage with healthcare outside of services attending to pregnant women. This may be the only point of contact with younger women or those from deprived backgrounds including some women who have multiple pregnancies with removal of their children into social care. 73 Immediate post-pregnancy contraception alongside flexibility in access points is therefore vitally important for equitable provision of contraception and tackling health inequalities. Whilst there is evidence that some groups, e.g. those from lower economic groups, may be at higher risk of unplanned pregnancy, targeted PPC can often be perceived as reproductive coercion. 74 Women in the UK in lower socioeconomic groups have been found to be more likely to access PPC which is in keeping with research in other high-income settings. 75 However, unplanned pregnancies in the UK occur across all socio-demographic groups. 76 Providing universally accessible services that support all women to achieve reproductive autonomy and control over their choices, rather than narrowly targeting specific and diverse high-risk groups, as well as being ethnically sound, are more likely to be effective. 77 Benefits of Pregnancy Spacing Birth spacing, facilitated by effective PPC, offers significant economic and social advantages for families. Adequate spacing between pregnancies allows parents more time to recover physically and emotionally from childbirth and early parenting demands. This recovery period can improve parental well-being Reprod Health Care. 2016 Apr;42(2):93-8; Thwaites A, Logan L, Nardone A, et al. Immediate postnatal contraception: what women know and think BMJ Sex Reprod Health 2019. 70 Kavanaugh ML, Carlin EE, Jones RK. Patient’s attitudes and experiences related to receiving contraception during abortion care. Contraception. 2011;84:585–593; Purcell C, Cameron S, Lawton J, Glasier A, Harden J. Contraceptive care at the time of medical abortion: experiences of women and health professionals in a hospital or community sexual and reproductive health context. Contraception. 2016 Feb;93(2):170-7; Aiken A, Lohr PA, Aiken CE, Forsyth T, Trussell J. Contraceptive method preferences and provision after termination of pregnancy: a population-based analysis of women obtaining care with the British Pregnancy Advisory Service. BJOG. 2017 Apr;124(5):815-824. 71 Roe AH, McAllister A, Sammel MD, Schreiber CA. Pregnancy intentions and contraceptive uptake after miscarriage. Contraception. 2020 Jun;101(6):427-431; Flink-Bochacki R, Hamm ME, Borrero S, Chen BA, Achilles SL, Chang JC. Family Planning and Counselling Desires of Women Who Have Experienced Miscarriage. Obstet Gynecol. 2018 Apr;131(4):625-631. 72 CoSRH Guideline: Contraception After Pregnancy. 73 Women’s Health, Commons Library Debate Pack. 74 Metcalfe A, Talavlikar R, du Prey B, Tough SC. Exploring the relationship between socioeconomic factors, method of contraception and unintended pregnancy. Reprod Health. 2016. 75 Malcolm Moffat, Robyn Jackowich, Christine Möller-Christensen et al. BJOG Published online: Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross- sectional study 2 April 2024; Morgan CR, Liu H. The relationship between area deprivation and prescription of long-acting reversible contraception in women of reproductive age in Lothian, Scotland, UK. J Fam Plann Reprod Health Care. 2017; 43: 281–288. 76 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; Metcalfe A, Talavlikar R, du Prey B, Tough SC. Exploring the relationship between socioeconomic factors, method of contraception and unintended pregnancy. Reprod Health. 2016; 13: 28. 77 Malcolm Moffat, Robyn Jackowich, Christine Möller-Christensen et al. BJOG Published online: Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study 2 April 2024; Thwaites A, Tran AB, Mann S. Women’s
Global and UK evidence shows that more than half of women resume sex in the first 6 weeks after childbirth or abortion. 63 The traditional UK model of waiting until the 6-week postnatal check with a GP to discuss contraception therefore misses the critical early window when fertility returns and when many couples resume sex. 64 It also fails to meet the needs of the most vulnerable in our society who do not access healthcare outside of early pregnancy, maternity, or abortion settings. 65 PPC is not currently routine clinical practice across all services outside of non-abortion settings. 66 A recent survey of over a thousand postnatal women in the northeast of England reported that less than half of the women had accessed a medically prescribed or administered form of contraception, only 15.5% had accessed a highly effective long-acting reversible method and 18.8% indicated that they were unable to access their preferred method of postnatal contraception. 67 Here, we aim to summarise the evidence on why it is important to address this gap now. Reproductive Autonomy and Equitable Access The power to decide if and when to have children is recognised as a fundamental human right. 68 Since evidence suggests that most women who give birth are not planning another pregnancy within a year, education on and access to PPC is therefore critical to enabling women to achieve their preferred number of children and pregnancy spacing. 69 By providing contraception before discharge from the maternity unit, healthcare providers support women’s reproductive autonomy during a busy and challenging period of transition when they may be focused on recovery and newborn care rather than contraceptive planning. Although similar data are not available in the context of abortion care, many women seeking termination are receptive to the 63 Malcolm Moffat, Robyn Jackowich, Christine Möller-Christensen et al. BJOG Published online: Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study 2 April 2024; McDonald EA, Brown SJ. Does method of birth make a difference to when women resume sex after childbirth? BJOG. 2013 Jun;120(7):823-30. doi: 10.1111/1471-0528.12166. Epub 2013 Feb 27. PMID: 23442053; Abebe Gelaw K, Atalay YA, Yeshambel A, et al. Prevalence and factors associated with early resumption of sexual intercourse among postpartum women: systematic review and meta-analysis. PLoS One 2024; Boesen, H.C., RØrbye, C., NØrgaard, M. and Nilas, L. (2004), Sexual behavior during the first eight weeks after legal termination of pregnancy. Acta Obstetricia et Gynecologica Scandinavica. 64 Speroff L, Darney P, Hohmann H, et al. The postpartum visit: it’s time for a change in order to optimally initiate contraception. Contraception. 2008;78(2):90-8. 65 Solomon D, Gibbs J, Burns F, et al. Inequalities in sexual and reproductive outcomes among women aged 16–24 in England (2012–2019) J Epidemiol Community Health 2024;78:451-457. 66 Malcolm Moffat, Robyn Jackowich, Christine Möller-Christensen et al. BJOG Published online: Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study 2 April 2024; BPAS, Contraception Re-Imagined: The Unfinished Revolution; Written evidence submitted by the College of Sexual and Reproductive Health (CoSRH) (MSI0006). CoSRH response to the Heath Select Committee’s Inquiry into Maternity Services and the National Maternity Review’s report Better Births: Improving outcomes of maternity services in England; Thwaites A, Tran AB, Mann S. Women’s and healthcare professionals’ views on immediate postnatal contraception provision: a literature review. BMJ Sex Reprod Health. 2019 Apr;45(2):88-94. 67 Malcolm Moffat, Robyn Jackowich, Christine Möller-Christensen et al. BJOG Published online: Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study 2 April 2024. 68 United Nations Population Fund (UNFPA). 2012. “By Choice, Not by Chance. State of World Population 2012.” New York. United States Agency for International Development (USAID). 1982. “USAID Policy Paper on Population Assistance.” Washington, DC. 69 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
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