Understanding the contraceptive needs of postnatal women
A survey of postnatal women on a postnatal ward has provided insight into their contraceptive needs.
Summary
A survey conducted on a postnatal ward found that almost half of women would prefer contraception provision on the ward.
Background
Postnatal women are at risk of rapid repeat, unplanned pregnancy with associated adverse outcomes for mother and child. A 2016 UK study found that almost one in 13 women presenting for abortion or delivery had conceived within 1 year of giving birth.
Recent Faculty of Sexual and Reproductive Healthcare (FSRH) guidance states that maternity service providers should ensure that all women have access to the full range of effective contraceptive methods and be able to provide these immediately after childbirth.
This is not currently routine clinical practice across UK NHS maternity hospitals.
What was involved
An anonymous, confidential, voluntary, cross-sectional survey of women was conducted on the postnatal ward of University Hospital Lewisham (UHL), London over a period of 6 weeks. The purpose of the survey was to determine:
- knowledge about postnatal contraception
- plans for postnatal contraception
- openness to choosing Long Acting Reversible Contraception (LARC)
- views as to when, where and by whom postnatal contraception should be provided
A total of 272 women were surveyed, 86% of all women on the postnatal ward during the study period.
Summary of findings
Knowledge and awareness of contraception and the recommended interpregnancy interval
Of the postnatal women interviewed:
- only 18% recalled a health professional speaking to them about contraception at any point during their pregnancy
- a third did not know or overestimated the earliest time period it is possible to get pregnant after having a baby
- 43% did not know the recommended interpregnancy interval or thought that this was less than 12 months
- for each LARC method, only a minority of women knew that they are safe in the immediate postnatal period or when breastfeeding
- 54% did not think any LARC methods were safe immediately postnatally, rising to 71% if breastfeeding
- approximately a quarter believed no LARC or hormonal postnatal options were safe if breastfeeding
Attitudes and views of the postnatal women interviewed
Although the vast majority were not planning a pregnancy in the next year, a third of women said they needed more information to decide on their postnatal contraceptive method.
Whilst 61% were intending to get their contraception from their GP, 47% said they would prefer to get their contraception on the postnatal ward before discharge.
Despite poor knowledge and experience of LARC, 46% said they were likely to accept LARC, if safe, on the postnatal ward.
Conclusions from the survey
Women on the postnatal ward currently lack essential knowledge to enable them to make informed decisions regarding their use and choice of contraceptive method.
The majority of women are not aware that LARC methods are safe in the immediate postnatal period and when breastfeeding.
Almost half of women would prefer postnatal contraception provision on the postnatal ward and said they were likely to accept LARC in this setting.
There is a need to pilot a service in England to offer all methods of contraception, including LARC, to all women on a postnatal ward. This should include effective, tailored contraceptive choices discussions with every woman during pregnancy as well as integrated planning for postnatal provision of her chosen method.
Further information
Contact Annette Thwaites by emailing annettethwaites@nhs.net.