Why was change needed? 

The refreshed framework for maternity care in Scotland (2011)1 states that a quality indicator for maternity services is achievement of improved provision of contraceptive advice and contraception, prior to discharge from postnatal care. The Lothian Sexual Health and HIV Strategy specifically states that a key goal is to reduce inequalities in sexual health.2 As part of NHS Lothian’s sexual health strategy a pilot project known as ‘APPLES’ (Access to Post Partum Contraception in Edinburgh South East) was implemented throughout 2014–2016.3 In Lothian, since 2006, the Prepare Team, comprising two specialist community midwives, has been providing comprehensive midwifery care to women with substance misuse problems. In the first few years of the service operating it became apparent to the team that a significant number of women had very short interpregnancy intervals. Prepare Team clients were an integral part of the APPLES cohort, and within the Lothian region one in thirteen women have been shown to have an interpregnancy interval of less than 1 year.4

Rapid repeat pregnancies in this client group potentially exacerbate other existing maternal health problems, and are associated with higher risks of preterm birth and neonatal death.5 6 The time required to detoxify among this group of women is also significant to avoid neonatal abstinence syndrome (NAS) or fetal alcohol spectrum disorder (FASD). Both NAS and FASD can have significant long-term effects on the health of the baby.7

What needed changing?

Accessibility to effective contraceptive methods including long-acting reversible contraception (LARC) needed to improve for this particularly vulnerable group of women who find it difficult to engage with mainstream services. It was felt that setting up an enhanced service to improve access to LARC methods such as the contraceptive implant could improve the quality of life for this client group, giving them greater reproductive control and …