Dr Malcolm Moffat Foreword: The Importance of a Universal Offer of Post-Pregnancy Contraception
Post-pregnancy contraception (PPC) should be a key part of a core public health offer. At its heart, it is about prevention, about taking an upstream approach to tackling the psychosocial and physical harms that we know occur downstream when pregnancies are unwanted and/or unplanned, particularly those conceptions that arise during the postpartum period. 7 This not only benefits individuals but also strengthens family and community networks, leading to impressive economic savings for health and social care services, which are currently under huge financial pressure. And, as with everything we do in public health, it is fundamentally about reducing inequalities.
Dr Malcolm Moffat is an Honorary Consultant in Public Health with a clinical background in women’s health, based at Newcastle University. His ongoing work on an NIHR Doctoral Fellowship is looking to determine a consensus approach to the delivery of PPC services in England.
Improving PPC provision across England represents an opportunity to address the deep disparities in unplanned pregnancies that currently exist.
receive less comprehensive care — we found that women who might be considered at higher risk of having a rapid repeat pregnancy were more likely to use PPC. 9 This included younger women and girls, especially those of teen age, women in households with a lower household income, women with multiple children, non-breastfeeding women, and women who reported that their pregnancy had been unplanned – all groups perceived to be at a higher risk of experiencing a short interpregnancy interval. Overall, it revealed that the targeted PPC provision in the Northeast and North Cumbria fell a long way short of reaching the whole local population and all the women who needed it. It can be persuasively argued that a universal approach to PPC provision is needed. PPC care must reach further into our communities and meet the needs of the larger group of all women, or we continue to fail to reap the public health benefits. Importantly, we have not adequately considered how a truly universal PPC offer might also involve male partners. Expanding our PPC offer to make services accessible not only to all women but also to all men represents an important
However, the current provision of PPC in the UK falls short of meeting the needs of our population, and remains patchy and uneven. This is despite the numerous examples of great PPC care being delivered by innovative and ambitious services across the country, many of which are represented in this report. As we reflect on these case studies, there is an opportunity to make the case for a PPC service that moves away from being a targeted offer to one that is truly universal. The Northeast and North Cumbria Postnatal Contraception (PoCo) Study was the first UK-based study to examine PPC provision across a whole UK region (the Northeast and North Cumbria Integrated Care System (NENC ICS), the largest Integrated Care System (ICS) in England) and across the whole pregnancy and postnatal pathway. 8 The study surveyed 2,500 women who had a term pregnancy in the preceding three years and asked them to describe their postnatal contraception experiences at multiple points in their maternity/postnatal pathways. Analysis of the results was surprising. Contrary to what is more typically seen in health research that reflects the ‘inverse care law’ — where people belonging to the most marginalised and underserved social groups typically
7 For more on the evidential basis for post-pregnancy contraception, see Appendix 2. 8 Moffat M, Jackowich R, Möller-Christensen C, Sullivan C, Rankin J. Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study. BJOG. 2024;00:1–8. https://doi. org/10.1111/1471-0528.17821.
9 Moffat M, Jackowich R, Möller-Christensen C, Sullivan C, Rankin J. Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study. BJOG. 2024;00:1–8. https://doi. org/10.1111/1471-0528.17821. 10 Boydell V, Smith RD, Global LARC Collaborative (GLC). Hidden in plain sight: A systematic review of coercion and Long-Acting Reversible Contraceptive methods (LARC). PLOS Glob Public Health. 2023:3(8): e0002131. https://doi.org/10.1371/ journal.pgph.0002131.
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