Elsevier

Contraception

Volume 65, Issue 3, March 2002, Pages 237-243
Contraception

Original research article
Is postpartum contraceptive advice given antenatally of value?☆

https://doi.org/10.1016/S0010-7824(01)00308-0Get rights and content

Abstract

In response to the concept that a good postpartum program should begin prenatally, this study was designed to determine whether the provision of expert contraceptive counseling during the antenatal period would have an impact on contraceptive uptake, patterns of contraceptive usage, and pregnancy rates during the first year after childbirth. Over 500 women attending antenatal clinics in each of three centers (Edinburgh, Scotland; Shanghai, People’s Republic of China; Cape Town, South Africa) were randomized to receive expert contraceptive advice (participants, n = 771) or the standard advice routinely given in that setting (controls, n = 866). Follow-up was by postal or interviewer-administered questionnaires at 16 and 52 weeks after childbirth. There were no significant differences in the prevalence of contraceptive use at one year (over 79% in all centers) between participants and controls. In Edinburgh, participants were more likely to undergo sterilization (p < 0.01) than controls, otherwise there were no differences among Edinburgh, Shanghai, or Cape Town in either the methods of contraception chosen or in the methods used over time. Contraceptive counseling delivered antenatally appeared to have no impact on the pregnancy rate during the first year after childbirth. In Shanghai, over 11% of women in both groups underwent termination of pregnancy in the year of follow-up. In conclusion, although women in all centers said they found the opportunity to discuss contraception antenatally was useful, it had very little effect on contraceptive use or on subsequent pregnancy rates.

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.

References (12)

  • A.F. Glasier et al.

    Who gives advice about postpartum contraception?

    Contraception

    (1996)
  • S. Thapa et al.

    Contraceptive use among postpartum womenrecent patterns and programmatic implications

    Internat Fam Plann Perspect

    (1992)
  • S.M. Walton et al.

    Family planning counselling in an antenatal clinic

    Brit J Fam Plann

    (1987)
  • S.B. Ozvaris et al.

    Acceptability of postpartum contraception in Turkey

    Adv Contracept Deliv Syst

    (1997)
  • M.H. Soliman

    Impact of antenatal counselling on couples’ knowledge and practice of contraception in Mansoura, Egypt

    East Mediter Health

    (2000)
  • J.I.B. Adinma et al.

    Contraceptive choices among Nigerian women attending an antenatal clinic

    Adv Contracept

    (1998)
There are more references available in the full text version of this article.

Cited by (0)

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).

View full text