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

In the postpartum period, fertility and sexual activity can return rapidly, placing women at risk of unintended pregnancy within the first 12 months following delivery. Unintended pregnancies during this period, particularly with short interpregnancy intervals, are associated with adverse maternal and neonatal outcomes. Postnatal contraception (PNC) counselling is often inconsistent, and gaps exist in both patient and provider knowledge and practices.

The objective of this study is to assess knowledge, attitudes, and practices of healthcare professionals and postnatal women regarding PNC and to evaluate the termination of pregnancy (TOP) clinic to review women seeking termination within 12 months of delivery in a UK district general hospital.

A cross-sectional, questionnaire-based survey of healthcare professionals and postnatal women was conducted between September 2024 and December 2024. In parallel, a retrospective study of women undergoing TOP between December 2023 and November 2024 was performed using electronic medical records. Quantitative survey data were analysed descriptively, and free-text responses were thematically analysed.

Fifty-seven healthcare professionals (73.7% midwives (n= 42/57), 26.3% (n= 15/57) doctors) and 60 postnatal women participated. All staff acknowledged the importance of PNC counselling, but midwives were more likely than doctors to view it as part of their role (83.3% (n= 35/42) vs 40% (n= 6/15)). Knowledge of early return of fertility was limited (26.6% (n= 4/15) of doctors; 7.1% (n= 3/42) of midwives). Common barriers included time constraints and workload, and most staff expressed interest in further training (92.8% (n= 39/42) of midwives; 80% (n= 12/15) of doctors), preferring online modules 58% (n= 33/57) or face-to-face sessions 28% (n= 16/57). Among women, 53.4% (n= 32/60) were multiparous, 43.3% (n= 26/60) reported the recent pregnancy as unplanned, only 26.6% discussed PNC postnatally, mostly verbally, and awareness of fertility returning as early as three weeks postpartum was low (13.3%; n= 8/60). The audit showed that 15.4% (n= 29 of 188) women underwent TOP within 12 months of delivery, indicating that approximately one in five women experienced unintended pregnancies shortly after childbirth.

Significant gaps exist in knowledge and counselling practices regarding PNC among both healthcare professionals and women. The findings underscore the need for systematic staff training and structured counselling pathways to improve timely uptake of contraception, reduce short interpregnancy intervals, and prevent unintended postpartum pregnancies.