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Understanding women’s views of and preferences for accessing postpartum contraception: a qualitative evidence synthesis
  1. Grace J Freeman-Spratt1,
  2. Jessica R Botfield1,
  3. Grace Soeun Lee1,
  4. Prithi Rajiv1,
  5. Kirsten I Black2
  1. 1Monash University, Clayton, Victoria, Australia
  2. 2University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Grace J Freeman-Spratt; grace.j.spratt{at}gmail.com

Abstract

Background Nearly half of women experience unintended pregnancies. These are associated with increased risk of poor maternal physical and psychosocial health outcomes. Many pregnancies in the first year postpartum are unintended, further increasing risks of poor outcomes and complications. We undertook a qualitative evidence synthesis to evaluate qualitative research on women’s views and preferences for accessing postpartum contraception, and identify evidence gaps and opportunities for postpartum contraception provision.

Methods Five databases were searched to identify relevant qualitative studies. Included studies focused on views of, and preferences for, accessing postpartum contraception for women of reproductive age in high-income countries.

Results Of 1854 studies identified, 28 full texts were assessed and 19 studies included. These were critically appraised using Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) and analysed using thematic synthesis. Included studies indicated the majority of women desire postpartum contraception, but face a range of financial, health system and personal barriers. Women felt unclear about the ideal interpregnancy interval (IPI) and the rationale for this. Women preferred contraceptive counselling at varying times both antenatally and postnatally, and commonly preferred to receive contraception in the immediate postpartum period before hospital discharge. Women commonly saw their obstetrician or general practitioner for contraceptive counselling, but welcomed midwifery involvement.

Conclusions Most women were interested in postpartum contraception and pregnancy spacing, but felt unclear about the optimal IPI, highlighting the need for further education and support around this issue. Contraceptive counselling was viewed as valuable antenatally and postnatally, and by varying maternal health providers, as was the provision of immediate postpartum contraception.

  • contraception behavior
  • Contraceptive Agents, Female
  • Counseling
  • family planning services
  • qualitative research
  • Reproductive Behavior

Data availability statement

Data are available in a public, open access repository.

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Footnotes

  • Contributors JB designed the research question and supervised the study. JB and GSL contributed to the background and acquisition of studies. GFS contributed to the design of the study. PR performed data extraction. JB and GFS performed analysis and interpretation of the data. GFS and GSL assessed confidence in review findings. GFS drafted the original manuscript with input from JB. KB provided intellectual input during the review process. GFS is the guarantor. All authors critically revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.