The Influence of Prenatal Counselling on Postpartum Contraceptive Choice

Abstract

This study tested the hypothesis that individual counselling in the third trimester would increase postpartum contraceptive use to a greater extent than only providing an educational leaflet. A total of 180 third trimester pregnant women of mean age 28.3 years who were attending Marmara University Hospital for prenatal care were enrolled. One-third were randomly allocated to receive prenatal contraceptive counselling and the remaining two-thirds (control group) received an educational leaflet. Participants were followed-up at 6 -9 months postpartum. The majority of subjects (91.5%) wanted to use contraception after delivery but 26.7% did not know which method to use. At followup, 79.6% of all women had begun a postpartum contraceptive regime and 68.7% were using a modern contraceptive method. Overall, there was no statistically significant difference in postpartum contraception use between the control and intervention groups in this study population. It is, therefore, concluded that prenatal counselling was not superior to educational leaflets for increasing the use of effective and modern postpartum contraception.

Outreach and integration programs to promote family planning in the extended postpartum period

“…Educational interventions included 1 or more counseling sessions about contraception and/or breastfeeding during the prepartum period [26–31], on the postpartum ward [32–35], or during the later postpartum period in the clinic [30,32]. The studies varied in the duration of follow-up, which ranged from 6 weeks to 12 months.…”

“…Of the 10 studies [26–35] evaluating educational interventions, 5 studies [27,30–32,34] of poor to good quality showed an improvement in contraceptive use, and 2 showed a decrease in repeat pregnancy within 12 months [30] or 9 months [27]. In a randomized controlled trial conducted in Pakistan [34], the intervention group received a 20-minute counseling session along with a 1-page leaflet after delivery.…”

“…Other studies of prenatal contraception counseling [26,28,29] and post-delivery counseling [33,35] showed no effect on contraceptive use [26,28,29,33,35] or repeat pregnancy [28]. …”

Postpartum Contraception in Publicly-Funded Programs and Interpregnancy Intervals

“…Studies suggest that initiation of contraception during the postpartum visit may be facilitated through closer hospital-outpatient linkages 19,20 and clinic protocols that repeatedly inform women about contraceptive options in their postpartum period. [21][22][23] Clinic protocols also should facilitate the use of any medical visit during the postpartum period to counsel and dispense contraception, even if the primary reason for the clinic visit was not family planning and including visits to the pediatrician for the infant. Family planning settings should be encouraged to schedule combined appointments for mother and infant so that the contraceptive discussion is a part of the infant-visit checklist each time in the first 3 months.…”

A select issue in the postpartum period: contraception

“…38,40 The effectiveness of counseling interventions in reducing unintended pregnancy and increasing postpartum contraceptive use, however, has been seldom examined. 39,43 Of those studies investigating the topic, several have concluded that focused contraceptive counseling in the postpartum or antepartum period is effective, [45][46][47] yet others report no impact on contraceptive use following contraception counseling 48 alone, versus educational leaflets, 49 or a short-term increase in contraceptive use only. 40 A systematic review (2010) of contraceptive counseling interventions taking place in the postpartum period, including both short-term and multiplecontact interventions, concluded that postpartum contraceptive education led to more contraception use and fewer unplanned pregnancies, though, was based on a limited number of studies.…”