BEYOND BARRIERS: REIMAGINING ACCESS TO POST-PREGNANCY CONTRACEPTION A GUIDE FOR BEST PRACTICE
curriculum for midwifery students, with external SRH specialists now providing comprehensive lectures on this subject for Scottish Universities. Scottish Government funding has also supported three Scottish Postpartum Contraception conferences between 2019 and 2025. These have served as an opportunity for shared learning and networking, and a stimulus for ongoing enthusiasm to progress this work. Programmes have generally featured clinical, research and policy updates as well as practical training workshops in implant and PPIUD insertion. They are attended by the Women’s Health Champion and members of the Government’s Women’s Health policy teams, serving to further strengthen links between clinicians, researchers, and policymakers. One of the most powerful sessions from the most recent conference was a session dedicated to patient experts speaking about their personal experiences of postpartum contraception, including the difficulties that they had faced in trying to access this and the improvements they had observed over time during their subsequent pregnancies. Information for service users Women have been central to all aspects of PPC research and development work in Scotland. A further aim of the government- funded national project was to provide women with high quality, reliable and consistent information about PPC and several new national public-facing resources have been developed. The first of these has been the creation of a new audio-visual animation for use during the antenatal period. This short video highlights the importance of postpartum contraception and encourages individuals to consider their options and include this as part of their birth plan. The animation was developed in close collaboration with staff and service users and is available in several languages. 129 It is available on NHS Inform, NHS Scotland’s comprehensive public health information site, and has also been integrated into patient accessible electronic maternity records in some regions to be accessed routinely as part of pregnancy care. The series has since been expanded – a PPIUD animation is now publicly available, with implant and injectable versions expected later this year. There are also plans to further expand the public- facing content on NHS Inform to include myth-busting videos and infographics. To complement the animation series, we have also developed a new NHS Scotland patient information ‘leaflet’. The leaflet utilises the same design as the animation series, to emphasise consistency in messaging, reliability and user experience. It is available in both digital and printable formats, and translated into several languages, to accommodate different needs and preferences. Ongoing areas of action Significant progress has made in Scotland towards achieving ‘rapid and easily accessible postnatal contraception’, but consistent and universal provision of all methods is not yet a reality in many regions. Access to PPIUD insertion for individuals having a vaginal birth continues to be very limited to be limited to only two of the 14 regional health boards despite ongoing efforts to expand this.
A consistent finding throughout was the high acceptability of immediate postpartum contraceptive provision amongst service users, with the ‘convenience’ aspect often cited as central to this. Much of the initial evaluative work in Lothian was funded through dedicated research grants and endowment funding, which also indirectly supported capacity building within PPC service delivery through staff training and resource development. By demonstrating unmet need and instigating the implementation process, stakeholder support was harnessed to continue these services beyond the research evaluation period. Having been ‘early adopters’ of immediate PPC service delivery, Lothian sought to and to utilise their lessons learned to support other parts of Scotland with their own implementation and scale-up of services. 127 The Scottish PPC Network 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 of the 14 Scottish Board areas continuing to meet on a quarterly basis. The formation of the network coincided with the release of the Women’s Health Plan for Scotland in 2021, which included ‘rapid and easily accessible postnatal contraception’ as one of its key priority areas. 128 Although PPC work had already commenced in several Scottish regions at the time, this policy served as a further catalyst to reframe this objective through a more national lens and to focus on a ‘Once for Scotland’ approach to improving PPC provision. One of the early aims of the network was to simplify access to training and education for maternity staff, and to reduce inconsistency between regions to support larger scale PPC delivery. In 2023, the network coordinated a successful bid for government funding to support a three-year project focused on PPC training, implementation and resource development across NHS Scotland. Training and education for staff The first of these was a two-part national webinar series, ‘ABC of PPC’ delivered to over 400 NHS Scotland healthcare professionals. To allow flexible access, the sessions were recorded and made available to watch later on-demand. In addition, a new dedicated e-learning module on postpartum contraception has also been developed in conjunction with NHS Education for Scotland and is now available on the national NHS Scotland professional development platform (TURAS). This platform also hosts a range of useful supporting resources for healthcare professionals to access including training pathways, standard operating procedures, and Patient Group Direction (PGDs) to support contraceptive provision in maternity settings. Several initiatives are underway to expand PPC education and training to other members of multidisciplinary team: For example, in 2024, Ayrshire & Arran supported the first hospital pharmacist to complete training in contraceptive implant insertion to enhance postnatal ward provision. Work is also underway to further integrate PPC into the undergraduate Feasibility 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(13):2009-15. 125 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. 126 Croan L, Craig A, Scott L, Cameron ST, Lakha F. Increasing access to contraceptive implants in the postnatal period via a home insertion service by community midwives. BMJ Sexual & Reproductive Health. 2018 Jan 1;44(1):61-4.
127 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. 128 Scottish Government, Women’s Health Plan. 129 Cooper M, Robinson H, Hughes L, McCabe K, Simpson J, Cameron S. Developing an accessible audiovisual animation to provide information about postpartum contraception. BMJ Sexual & Reproductive Health. 2024 Jul 1;50(3):226-9.
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