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LARC and postpartum contraception in focus
Alongside the new UK Medical Eligibility Criteria (UKMEC) criteria, which give long-acting reversible contraceptive (LARC) methods even greater prominence, this journal issue presents UK and international data related to both intrauterine device (IUD) and other LARC use. Not all of it is optimistic. Given that short inter-pregnancy interval is associated with adverse outcomes, the immediate postpartum period ought to be an ideal time to establish effective contraception. But quantitative and qualitative studies from the UK, India and Guyana identify barriers to the discussion about and fitting of LARC, postpartum. Opportunities to discuss it are frequently missed both in the third trimester and before discharge, in both India and Scotland. Data from an Edinburgh obstetric unit also point to gaps between women's plans for inter-pregnancy interval and the observed reality. Limited access to LARC insertion before discharge from the obstetric use appears to hinder some women otherwise interested in using these methods. Meanwhile at the 6-week postpartum check, qualitative research identifies further, often organisational, barriers to LARC fitting; these include making time for counselling and extra appointments for fitting.
Revised UKMEC place LARC first and are UK focused
The new UKMEC begin with a noticeable change of order, and hence emphasis, with LARC methods presented first, followed by medium- and then shorter-acting methods, with sterilisation and barrier methods removed altogether. Similarly, for emergency contraception, the IUD is presented before ulipristal acetate, with levonorgestrel in third place. The categorisation of diseases such as viral hepatitis or diabetes has been reordered to allow a more patient-centred judgement about the applicability of a method to a given individual, while schistosomiasis and malaria, uncommon in the UK, have been removed. Raynaud's phenomenon, whose risk relates to the underlying disease, has also gone, and advice regarding systemic lupus erythematosus has been simplified and clarified. Conversely, increasingly prevalent conditions such as bariatric surgery, …
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