A Guide for Best Practice Beyond Barriers: Reimagining Access to Post-Pregnancy Contraception
“I’ve seen how it empowers women—we’re offering something practical and important at exactly the right time.” – PPC Provider Overview This report offers best practice approaches for local and regional delivery, aimed at Integrated Care Board (ICB) leaders, managers in hospital Trusts, and other healthcare commissioners. The companion report: Beyond Barriers: Reimagining Access to Post-Pregnancy Contraception - The Case for Change outlines the strategic, policy, and funding actions needed to drive system- wide improvement in PPC provision. The report audience is aimed at parliamentarians, ICB leaders, and national policymakers. The report outlines the case for change from the current situation of a ‘postcode lottery’ where high-quality PPC services – although present in regions across the UK – are not standard practice. While each report stands alone, they are designed to be read together, offering a comprehensive framework for advancing PPC policy and practice across the UK. What is post-pregnancy contraception (PPC)? Post-pregnancy contraception includes provision of contraception to women after childbirth, abortion, ectopic pregnancy, miscarriage, or gestational trophoblastic disease (GTD). In this report, post-pregnancy contraception also refers to the provision of contraception following stillbirth and baby loss. Background Access to post-pregnancy contraception remains a luxury for many women in the UK, and in some regions, access is virtually non-existent, as shown by the following statistics: • In Britain, around 45% of pregnancies are unplanned or ambivalent. 1 • Almost 1 in 13 women presenting for an abortion or birth had conceived within a year of a previous birth. 2 • 1 in 8 women who have delivered one or more children conceive and continue another pregnancy within a year of a previous birth. 3 • Abortions are at a record high, with a 17% increase in comparison to the previous year in 2022. 4
• Almost a fifth of women are unable to access their preferred method of postnatal contraception. 5 Despite a clear incentive for PPC provision, many women face significant barriers to access. Access to PPC is currently a ‘postcode lottery’ due to existing commissioning structures, which mean that there is no clarity of responsibility in terms of who should provide post-pregnancy contraception. Why is access to post-pregnancy contraception important? 1. Women want PPC Providing information about contraception options during pregnancy allows women to make informed decisions about if and when they wish to get pregnant again. 2. PPC produces significant cost savings Providing contraception service in maternity settings has an estimated ROI of £32 savings to the public sector for every £1 invested. 6 3. PPC supports safe maternity care PPC is integral to supporting safe maternity care by supporting women to have all necessary information and informed choice. Importantly, improved provision of PPC helps to tackle common myths and misconceptions around women, pregnancy, contraception and fertility. 4. Access to PPC reduces health inequalities Contributors to this report demonstrated the positive impact of PPC in tackling health inequalities in their local area. By flexibly providing contraception to women post-pregnancy in circumstances that suited them, they are improving women’s outcomes, particularly those who may find it harder to access SRH services. Opportunities Many regions across the UK have set up successful PPC services, many of which have provided case studies for this report. However, these exemplary services are not standard, and many potential providers struggle to set up a PPC service due to the barriers of existing commissioning structures.
1 The National Survey of Sexual Attitudes and Lifestyles (Natsal-3). 2 Heller R, Cameron S, Briggs R et al. Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals. J Fam Plann Reprod Health Care. 2016;42(2):93-8. 3 Heller R, Cameron S, Briggs R et al. Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals. J Fam Plann Reprod Health Care. 2016;42(2):93-8.
4 Office for Health Improvement and Disparities. Abortion statistics for England and Wales: 2022. 5 Moffat M, Jackowich R, Möller-Christensen C et al. Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study. 2024; 131(10): 1360–1367. 6 Public Health England. PHE Women’s Reproductive Health Programme 2020 to 2021.
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