What is postpartum contraception and why is it important?

Contraception has become central to our country’s health policy as well as the public health system. So far, population control imperatives have driven most of the awareness programmes. However, not enough has been said about the need for awareness on postpartum contraception, which is disconcerting, because it is possible to become pregnant soon after having a baby.

New parents are often ill informed about the kind of contraception they should use after delivery and how soon after child birth this should be initiated. I would like to explain the importance of postpartum contraception and the options available to new parents.

Postpartum contraception and the need gaps that exist Postpartum contraception focuses on the prevention of unplanned and closely spaced pregnancies during the first six months following childbirth. In India, 46 per cent of women do not use any contraception during the postpartum period.

This means that an unacceptably high proportion of the population is at risk of an unplanned pregnancy, because of lack of access to and understanding of family planning and contraception options after child birth. According to World Health Organization (WHO) estimates from 57 countries, 32 per cent to 62 per cent of postpartum women ‘have an unmet need’ for family planning.

Why postpartum contraception is important
Using a birth control method in the six months that follow child birth (called the postpartum period) helps new parents avoid an unplanned pregnancy and the health risks that accompany closely spaced pregnancies. According to the WHO, closely spaced and ill-timed pregnancies and births contribute to some of the world’s highest infant mortality rates.

Closely spaced pregnancies also affect the mother’s health and increase the risk of maternal mortality. The effects of unplanned pregnancies are often seen for several months postpartum, with an increased risk of maternal depression and parenting stress.

Couples empowered with knowledge of postpartum contraception choices have better health outcomes and can better plan their own careers and the future of their children.

Know your postpartum contraception options

• IUDs: A copper-bearing intrauterine device (IUD) is a contraceptive that can be inserted in the uterus immediately or up to 48 hours after birth. IUDs can also be inserted 4 weeks after delivery.
• Progestin-only methods – DMPA (depot medroxyprogesterone acetate)
• Injections and pills: For women who breastfeed, progestin-only injections and pills can be initiated at 6 weeks following birth. The DMPA injection is given just once every 3 months while the progestin-only pill needs to be taken once daily. For non-breastfeeding women, experts recommend progestin-only methods immediately following birth.
• Combined Oral contraceptives: Combined estrogen and progestin pills should only be given 6 months after birth, after cessation of breast feeding.
• Condoms: All women, regardless of whether they breastfeed or not, can initiate the use of condoms as a form of contraception after child birth.
• LAM (lactational amenorrhea method) or exclusive breastfeeding: Breastfeeding after childbirth is known to be a natural form of contraception, medically referred to as the LAM. Mothers should however plan to switch from LAM to another form of contraception by the time the infant reaches six months of age.
• Female sterilization: Female sterilization or tubal ligation can be performed immediately or up to four days after birth, or any time after six weeks postpartum. However, this is a permanent method and is only an option for women who are sure they do not want to have any more children.

These options should be discussed with your obstetrician-gynecologist in the weeks leading up to delivery so that you are ready to choose a method that suits you best soon after delivery. The writer is an Obstetrics and Gynecologist at Shalini Hospital, Hyderabad

By Dr P Balamba