Original research articleIs postpartum contraceptive advice given antenatally of value?☆☆
Introduction
Family planning providers have traditionally regarded the postpartum period as an opportunity for introducing and promoting contraception. In many developing countries special programs for the delivery of postpartum family planning services have been in existence since the 1960s [1]. In the UK, family doctors are paid to undertake a “postnatal check” for all postpartum women six weeks after childbirth, and almost all discuss contraception at that consultation [2]. A similar situation exists in Cape Town where women are seen during the first week postpartum and then referred for a later check to the local family planning clinic. In Shanghai, the emphasis is on antenatal care and there is no postnatal check.
Contraception—indeed sex—is probably the last thing on a new mother’s mind during the first few days after delivery, yet leaving the discussion until later in the postpartum period may mean missing the opportunity altogether. Most women, even in the least developed countries, have some contact with health providers during their pregnancy, and yet the opportunity of giving advice about contraception during the antenatal period is often neglected. In a study of 174 women delivered at a large Scottish teaching hospital [2], only 4% discussed contraception antenatally, and advice given by a variety of health professionals after childbirth was often felt by the women to be inappropriate and insensitively timed.
In Cape Town, efforts are made in the antenatal clinics to raise awareness of postpartum contraception, usually in the form of group sessions led by the family planning advisors or clinic sisters. In Shanghai, all expectant mothers do attend antenatal courses, but the details given about contraceptive options available to them postpartum is limited.
In response to the concept that a good postpartum program should begin prenatally, we designed a study to determine whether the provision of expert contraceptive counseling during the antenatal period would have an impact on contraceptive uptake, patterns of use, and pregnancy rates during the first year after childbirth. The study was undertaken by the Contraceptive Development Network in two developing countries, the People’s Republic of China (Shanghai) and South Africa (Cape Town), and one developed country, Scotland (Edinburgh).
Section snippets
Participants and methods
In Edinburgh and Shanghai, women were recruited from a single large maternity hospital in each city. In Cape Town, recruitment was from three maternity obstetric units (MOU) outside the city in Guguletu, Mitchell’s Plain, and Retreat, run by midwives providing a community-based antenatal and delivery service linked to secondary and tertiary hospitals. Recruitment started in the three centers between February and August 1997. In Edinburgh and Cape Town antenatal clinic sessions were randomized
Results
In all centers, delivery details were checked before first contact was made at 16 weeks after childbirth, and women who had experienced severe pregnancy complications (including stillbirth or neonatal death) were discontinued from the study. In addition, those who ultimately did not deliver at the study site were discontinued from the study, with the exception of Cape Town where participants continued to be followed-up if they had been referred to a secondary or tertiary hospital for delivery.
Discussion
Although women in all centers said they found the opportunity to discuss contraception antenatally was useful, it did not make any difference to patterns of contraceptive use postpartum. There was one small exception; in Edinburgh more women in the group receiving antenatal advice were sterilized subsequently by 16 weeks. In Edinburgh, the family planning nurse routinely discussed sterilization with women who stated that they planned no further pregnancies, gave advice about the most
Acknowledgements
The authors thank the following staff for administering the questionnaires: in Edinburgh, Sister Ann Mayo; in Cape Town, Ms. Marion Heap, Sister Anne Hoffman, Ms. Bridgette Mangu; and in Shanghai, Dr. Xiaoyu Hu. The authors also thank Mrs. Meg Anderson for typing the manuscript.
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The three centers in this study are part of the Contraceptive Development Network, which is funded by the Medical Research Council and the Department for International Development (G9523250).