To avoid unplanned, rapid repeat pregnancies, women are recommended to use effective contraception by day 21 postpartum. This study describes postpartum contraception use, impact of contraception counselling, and structural barriers to access from the perspective of doctor-mothers who have knowledge of health systems and high health-literacy.
This is a secondary analysis of a survey which compared postpartum contraception use in women who had conceived spontaneously versus with in vitro fertilisation, using data from doctor-mothers who conceived spontaneously. Contraception use over time is presented as a Sankey plot. Chi-squared or Fisher’s exact tests compared contraception effectiveness by sociodemographics and pregnancy planning. Qualitative data on contraception counselling experience were analysed using thematic analysis.
Of 634 records, 177 participants were eligible for analysis, with 72 providing qualitative data. Most (146/177, 82.5%) reported vaginal sex post-birth, and 19.8% had had sex within 6 weeks. Only 11.6% (17/146) of sexually active participants used very effective methods as first contraception. Greater contraception effectiveness was associated with earlier initiation (p<0.001). Of sexually active participants who initiated contraception within 3 weeks postpartum, 92.3% (12/13) used effective or very effective methods. Counselling only at place of birth was associated with initiation of effective contraception (p=0.041). Qualitative analysis of counselling experience generated three themes: (1) counselling style, (2) multidisciplinary working and (3) need for self-advocacy.
Use of effective postpartum contraception was low overall, despite a highly health-literate population. Counselling at place of birth has a potentially significant impact on the individual. Of those who initiated contraception before 3 weeks, almost all chose effective methods indicating acceptability where available.