Postpartum Family Planning: Methods to Decrease Unintended Pregnancies

Abstract

Postpartum women are at high risk for unintended pregnancies and subsequent adverse perinatal outcomes often due to insufficient pregnancy intervals. There is a high burden of unmet family planning need caused by factors including inadequate education on postpartum contraception, limited access to healthcare professional in the immediate postpartum period, and lack of access to contraceptive options. This chapter will discuss the different contraceptive methods that can be utilized and their respective efficacies, venous thromboembolism (VTE) risk, and impact on lactation. Tubal ligation, lactation amenorrhea, barrier methods, the copper intrauterine device (IUD), and progestin-only pills (POP) have no clinically significant impact on VTE risk or lactation for the majority of women postpartum. Depot medroxyprogesterone acetate (DMPA) injection, implants, and levonorgestrel (LNG) IUDs are considered to have no impact on breastfeeding based on limited clinical evidence. Contraceptive methods that contain estrogens may increase a woman's risk for VTE in the peri-partum period and should be deferred approximately 30 days postpartum. Sterilization and long acting reversible contraceptives (LARC), including IUDs and contraceptive arm implants, have been proven to be the most reliable and cost-effective methods, which also have high rates of patient satisfaction and continuation. Women have a range of safe contraceptive choices they can use to prevent pregnancy or to space their pregnancies. Health care systems should empower women to become educated about and gain access to postpartum contraception so as to address unintended pregnancy disparities among this group of women. Above all, counseling should be patient-centered when choosing the right method for the woman.