Evidence Hub

Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study

Providing family planning care during the postnatal period (the eight-week period after a birth) is important in protecting the health and wellbeing of new mothers.

Babies born after a short gap between pregnancies are more likely to have a low birthweight and to be born prematurely. Mothers can also experience social and psychological harms because of unplanned and unwanted pregnancies, particularly while caring for a newborn baby.

In this study, we gathered the experiences of 2,509 women who had completed a pregnancy during the previous three years, using an online survey. Women described their experiences of PNC care as well as sharing broader descriptions of the care they had received during pregnancy and the postnatal period.

We found that the uptake of the most reliable PNC methods was low in this sample, and that almost 1 in 5 women were not able to access their preferred PNC type.

We also found that some women were more likely to access the most reliable PNC methods than others (including younger women, women with a lower household income, women who delivered by Caesarean section, and women who reported that their pregnancy was unplanned).

White British women and lesbian/bisexual/queer women were more likely to say that they had not been able to access their preferred PNC type.

This research shines a light on the current nature of PNC provision in the North East region, with evidence of low PNC uptake associated with more targeted provision of services.

Expanding PNC care to make it accessible to all new mothers has the potential to result in population-level impact.

This is the first study in the UK to look at experiences of PNC care across a whole region and across the whole pregnancy-postnatal pathway.

Who is this evidence useful for?

Policymakers, clinicians (obstetricians, midwives, GPs, health visitors, sexual health clinicians), women’s health researchers

What is the issue?

• Being able to access safe and reliable family planning care after having a baby is important in protecting the health and rights of women and their wider family networks.
• Babies born after a short gap between pregnancies are more likely to have a low birthweight and to be born prematurely. There are also likely to be social and psychological harms to mothers associated with unplanned and unwanted pregnancies, particularly while caring for a newborn baby.
• Although medical organisations recommend that women should be able to access all postnatal contraception (PNC) methods immediately after having a baby, research in other settings has shown that services often fall short in providing good, accessible PNC care.

Research summary

• The purpose of this study (the North East and North Cumbria Postnatal Contraception (PoCo) Study) was to explore women’s experiences of postnatal contraception care in the North East of England.
• Women who had had a baby in the region in the last three years were invited to complete an online survey. More than 2,500 responses were received during the period December 2022 to April 2023. Survey responses were analysed by researchers at Newcastle University.
• The results reported in this paper describe the headline findings in relation to PNC uptake, access to preferred PNC methods, and differences in uptake in relation to individual and pregnancy-related characteristics.
• Future published work will look at how other factors are linked to PNC uptake and will also report responses where women described their experiences of care.

What the research found

• Relatively few women said that they had used the most effective PNC methods during the 8-week period after having a baby. 38.7% of respondents used a PNC method that had been prescribed or provided by a healthcare professional, but only 15.5% of respondents used a long-acting reversible contraception (LARC) method (including coils, injections, and implants).
• As almost half (47.1%) of respondents reported that they had engaged in some form sexual activity during this period, a significant proportion of survey participants are likely to have been at risk of having a rapid repeat pregnancy.
• Almost 1 in 5 (18.8%) respondents said that they had not been able to access their PNC method of choice/preference.
• Women who were younger, had a lower household income, had four or more previous term pregnancies, delivered by Caesarean section, reported that their pregnancy was unplanned and didn’t breastfeed were found to be more likely to use more effective PNC methods.
• White British women and lesbian/bisexual/queer women were more likely to say that they had not been able to access their preferred PNC method.

Why is this important?

• This is the first study in the UK to look at experiences of PNC care across a whole region and across the whole pregnancy-postnatal pathway.
• PNC provision is an important element of postnatal care, but the findings reported here suggest that many women in the North East and North Cumbria struggle to have their PNC needs properly met, putting them at risk of unplanned and unwanted pregnancies shortly after having a baby.
• Women in groups that might sometimes be considered high risk for unplanned pregnancy were found to be more likely to access reliable PNC methods, suggesting that healthcare organisations currently provide targeted care that is focused on those with the greatest perceived need. However, although uptake in these groups was higher, it was still lower than might be desired.
• Making sure that all women are able to access the PNC care that they want and need is important in supporting women to take control of their reproductive health in the crucial period after completing a pregnancy. Targeted care, while important, is unlikely to achieve the kind of PNC coverage that will have a meaningful impact on women’s health across the population.

How were people/community groups/patients involved in this work?

• A patient and public advisory panel, of women who had recently completed a pregnancy, supported the design and delivery of this work. Community groups as well as NHS organisations also supported us in sharing the opportunity to complete the online survey.

What’s next?

• A follow-up paper will look at the extent to which healthcare provider practices were associated with PNC uptake.
• Future papers will explore the relationship between PNC uptake and breastfeeding, and will report women’s narrative accounts of the PNC care they received.
• The authors are working with policymakers and clinicians to ensure that the findings reported here and in future PoCo study papers result in meaningful changes to the way in which PNC services are designed and delivered.

Read the full research paper

Demographic and pregnancy-related predictors of postnatal contraception uptake: A cross-sectional study – published in BJOG: An International Journal of Obstetrics and Gynaecology, March 2024

Get in touch about this research

Dr Malcolm Moffat

[email protected]

@MalcolmMoffat19