Contraception after pregnancy

Abstract

Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

Utilisation, effectiveness, and safety of immediate postpartum intrauterine device insertion: a systematic literature review

“…9 However, in 2019, only 6.5% of reproductive-age women in higher-income countries and 3.0% of women in lower-income countries used an IUD. [7][8][9] In several studies, the proportion of women consenting to PPIUD insertion prenatally was higher than the proportion later receiving the intervention;…”

A Questionnaire-Based Study to Evaluate Health-Related Behaviors in 602 Women of Reproductive Age in Poland

“…The importance of contraception after pregnancy should be emphasized here [ 34 , 35 ]. The Lactational Amenorrhea Method (LAM) is a recognized contraceptive method that ensures a 98% protection against pregnancy on condition that, among others, menstruation has not appeared since delivery and that the child is entirely or almost entirely breastfed and is younger than 6 months [ 35 ].…”

“…On a global scale, contraception after delivery prevents approximately 30% of deaths of mothers and 10% of deaths of infants if the pregnancies are spaced at least 2 years apart. Therefore, the WHO recommends waiting at least 2 years after delivery before the next pregnancy [ 34 ]. In our own study we observed that the majority of pregnant women did not use any contraceptive agents, while more than half of the women who had given birth to a child within the last 12 months used contraceptive agents.…”

Achieving Equity in Postpartum Contraception Access

“…Because both ovulation and initiation of sexual activity often occur within the first months postpartum, access to contraceptive methods should be prioritized during this time period to prevent short interpregnancy intervals. 14 The immediate postpartum window is also considered a time of heightened motivation for pregnancy prevention among those who have recently given birth and are likely caring for an infant. Nevertheless, there is a remarkable unmet need for contraception among postpartum people in the United States, with fewer than 50% of postpartum visits incorporating contraceptive counseling, regardless of insurance type.…”