From Birth to Unintended Pregnancy: Postnatal Contraception Failures in the First Postpartum Year

Area of Science:

• Reproductive Health
• Maternal Health
• Public Health

Background:

• Rapid return of fertility postpartum increases risk of unintended pregnancy within 12 months.
• Short interpregnancy intervals are linked to adverse maternal and neonatal outcomes.
• Inconsistent postnatal contraception (PNC) counselling highlights gaps in patient and provider knowledge.

Purpose of the Study:

• Assess knowledge, attitudes, and practices of healthcare professionals and postnatal women regarding PNC.
• Evaluate termination of pregnancy (TOP) clinic data for women seeking abortion within 12 months postpartum.

Main Methods:

• Cross-sectional questionnaire survey of 57 healthcare professionals (midwives, doctors) and 60 postnatal women.
• Retrospective audit of electronic medical records for 188 women undergoing TOP within 12 months postpartum.
• Descriptive analysis of quantitative data and thematic analysis of free-text responses.

Main Results:

• Limited knowledge of early postpartum fertility return among both staff (doctors 26.6%, midwives 7.1%) and women (13.3%).
• Barriers to PNC counselling include time constraints and workload; staff desire further training.
• Only 26.6% of women discussed PNC postnatally, and 15.4% of audited women underwent TOP within 12 months postpartum.

Conclusions:

• Significant deficits in PNC knowledge and counselling practices exist among healthcare providers and women.
• Systematic staff training and structured counselling pathways are crucial for improving PNC uptake.
• Interventions are needed to reduce short interpregnancy intervals and prevent unintended postpartum pregnancies.