title: Postpartum contraception: a missed opportunity to prevent unintended pregnancy and short inter-pregnancy intervals.
abstract: BACKGROUND
  Women in the postpartum period need effective contraception. Unintended pregnancies soon after childbirth may lead to abortion or short inter-pregnancy intervals associated with adverse outcomes. Using databases for a 6-month period (September 2013-February 2014) we examined the proportion of women attending for abortion in Edinburgh, Scotland who had given birth in the preceding 12 months, and the proportion of women giving birth in this region after an inter-pregnancy interval of 12 months or less. We also surveyed 250 women prior to discharge from the same maternity service about their contraceptive intentions.
  
  
  RESULTS
  Some 75/1175 (6.4%) attending for abortion had given birth within the preceding 12 months and 332/4713 (7.0%) postpartum women gave birth following an inter-pregnancy interval of 12 months or less. When considering parous women, percentages were 13.3% and 13.9%, respectively. The majority (n=237, 96.7%) of postpartum women were not planning another pregnancy within the year but only a minority (n=32, 12.8%) were planning on using long-acting reversible contraception (LARC), namely the implant or intrauterine device. However, 42.8% (n=107) indicated that if the implant or intrauterine contraception could be inserted before they left hospital then they would choose these methods (p<0.0001).
  
  
  CONCLUSIONS
  Almost one in thirteen women in our population presenting for abortion or giving birth has conceived within 1 year of giving birth. Provision of LARC immediately postpartum appears to be an attractive option to mothers, and could be an important strategy to prevent unintended pregnancy and short inter-pregnancy intervals.
authors.affiliation: Clinical Research Fellow, Chalmers Sexual & Reproductive Health Service, Edinburgh, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Heller
authors.affiliation: Consultant Gynaecologist, Chalmers Sexual & Reproductive Health Service, Edinburgh, UK.
authors.forename: Sharon
authors.initials: S
authors.lastname: Cameron
authors.affiliation: Foundation Doctor, Midwife, Royal Sussex County Hospital, Brighton, UK.
authors.forename: Rosie
authors.initials: R
authors.lastname: Briggs
authors.affiliation: Midwife, Chalmers Sexual & Reproductive Health Service, Edinburgh, UK.
authors.forename: Norma
authors.initials: N
authors.lastname: Forson
authors.affiliation: Honorary Professor, Department of Obstetrics and Gynaecology, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Glasier
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000328:Adult; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D020380:Needs Assessment; D011181:Postnatal Care / Q000379:methods*; D049590:Postpartum Period; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D018570:Risk Assessment; D012606:Scotland; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female
keywords: abortion; long-acting reversible contraception; postnatal care; postpartum