Contraception after delivery: mothers should be better counselled about its need and alternatives
Jenni Liikanen1, Satu Suhonen2 1Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland, 2Centralized Family Planning, Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland - email@example.com
Objectives: Finland has low rates of induced abortions (8.6/1000 women aged 15-49 years, 2012). In Finnish guidelines of maternal care, contraceptive counselling at postpartum visits is emphasized. However, more than 10% of induced abortions are carried out in women who have given birth recently. Therefore the timing and content of this counselling can be questioned. The aim of this study was to examine women´s knowledge about return of fertility, options and use of contraception after delivery. Method: A cross-sectional questionnaire study was conducted 6 months after delivery at two maternity care units in the city of Helsinki, Finland. Results: 45 women returned the questionnaire during a 2 month period (response rate 55 %). Return of fertility after delivery in women not breastfeeding was poorly known. Only 16% (N=7) were aware of all the criteria of LAM (lactational amenorrhoea method) as a family planning method. From all available contraceptive methods most commonly only one was recommended. Condoms was the most popular contraceptive method (44.5%) used. Initiation of efficient contraception was delayed. The knowledge of the possibility of hormonal emergency contraception during breastfeeding was poor. Conclusions: Information about return of fertility, need for contraception, breastfeeding as a family planning method and available effective contraceptive methods is not given sufficiently after delivery. Thus there is an increased risk of unplanned pregnancy. Contraception after delivery and its need must be discussed and initiated early enough if a new pregnancy is not planned. The number of induced abortions during the postpartum period could be reduced if contraceptive counselling were to be improved, correctly timed and supported by the healthcare system. This promotes the psychological, physical, social and economical well-being of the woman and her family and is also cost-effective for the healthcare system.