Background

Unintended pregnancy remains a significant public health challenge in the 21st century. Up to 50% of all pregnancies are thought to be unintended at conception. Due to the rapid return of fertility and sexual activity, the postpartum period is high-risk for unintended pregnancy, and the need for effective contraception at this time has long been underestimated.

A short interpregnancy interval (defined as less than 12 months between childbirth and subsequent conception) is an independent risk factor for preterm birth, fetal growth restriction and stillbirth.1 Furthermore, many unintended pregnancies at this time will end in abortion, with an estimated one in thirteen women attending an abortion clinic in the UK within a year of giving birth.2

One of the key strategies to reduce unintended pregnancy and abortion at this time is already within our clinical armoury: long-acting reversible contraception (LARC). LARC is safe for use by most women, including during the immediate postpartum period and while breastfeeding.3 LARC methods are also the most effective at preventing unintended pregnancy and are highly cost effective. Initiating LARC immediately postpartum has also been shown to significantly reduce the risk of a short interpregnancy interval. But for a new mother, LARC can be the most challenging method to access.

After leaving the delivery suite, contraception is not usually a priority for women as looking after the newborn and recovering from childbirth predominate. But delaying this discussion until a postnatal check 6 weeks later with a general practitioner (GP) is also less than ideal. Increasing GP workloads and limited consultation times means that a full discussion and initiation of contraception can be challenging, especially for LARC methods which often require additional appointments to start. …