Understanding women’s views of and preferences for accessing postpartum contraception: a qualitative evidence synthesis

Abstract

BackgroundNearly half of women experience unintended pregnancies. These are associated with increased risk of poor maternal physical and psychosocial health outcomes. Many pregnancies in the first year postpartum are unintended, further increasing risks of poor outcomes and complications. We undertook a qualitative evidence synthesis to evaluate qualitative research on women’s views and preferences for accessing postpartum contraception, and identify evidence gaps and opportunities for postpartum contraception provision.MethodsFive databases were searched to identify relevant qualitative studies. Included studies focused on views of, and preferences for, accessing postpartum contraception for women of reproductive age in high-income countries.ResultsOf 1854 studies identified, 28 full texts were assessed and 19 studies included. These were critically appraised using Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) and analysed using thematic synthesis. Included studies indicated the majority of women desire postpartum contraception, but face a range of financial, health system and personal barriers. Women felt unclear about the ideal interpregnancy interval (IPI) and the rationale for this. Women preferred contraceptive counselling at varying times both antenatally and postnatally, and commonly preferred to receive contraception in the immediate postpartum period before hospital discharge. Women commonly saw their obstetrician or general practitioner for contraceptive counselling, but welcomed midwifery involvement.ConclusionsMost women were interested in postpartum contraception and pregnancy spacing, but felt unclear about the optimal IPI, highlighting the need for further education and support around this issue. Contraceptive counselling was viewed as valuable antenatally and postnatally, and by varying maternal health providers, as was the provision of immediate postpartum contraception.

Contraceptive uptake in postpartum people with and without opioid use disorder and opioid use with co-occurring substance use

“…The present analysis does not include people with OUD and poly-substance use who were not engaged in the healthcare system in the one year prior to conception, possibly leading to an overestimation of the true population level uptake of postpartum contraception. Nonetheless, numerous barriers to obtaining postpartum contraception exist that range from financial barriers (perceived cost of contraception and appointments) to health system barriers (method or appointment unavailability, lack of clinician training) to personal barriers (contraceptive misinformation, confusion about the optimal interpregnancy interval, societal or relationship pressure to have multiple children, prioritizing newborn over attending appointments)( Freeman-Spratt et al, 2023 ). Notably, women with OUD, both with and without co-occurring use of other substances, experience significant challenges in the postpartum period related to SUD treatment discontinuation ( Wilder et al, 2015 ), mental health symptoms, and return to substance use ( Stewart et al, 2023 ) that may serve as additional barriers to accessing postpartum contraception.…”