Healthcare‐Related Predictors of Postnatal Contraception Uptake: A Cross‐Sectional Study

ABSTRACT Background and Aims Postnatal contraception (PNC) care is an integral element of a comprehensive public health offer in the weeks and months following a pregnancy. The aim of this cross‐sectional survey study was to examine experiences of PNC care in relation to healthcare professional (HCP) engagement during and after pregnancy in an English region. Methods Women who had completed a pregnancy in the previous 3 years in the North East and North Cumbria Integrated Care System (ICS) were invited to complete an online survey. Main outcome measures reported in this paper are uptake of medically prescribed/administered contraception and uptake of long‐acting reversible contraception (LARC) during the postnatal period, and access to preferred PNC methods, in relation to healthcare experience at various points on the pregnancy/postnatal pathway. Results Most PNC care was accessed in primary care, but there was variation in setting of care associated with age, parity and pregnancy intention. Uptake of the most effective PNC methods and access to preferred PNC methods were positively associated with HCP engagement. PNC counselling prior to a planned Caesarean section (aOR 2.129 [1.362–3.327]), providing PNC on the postnatal ward prior to discharge (aOR 1.745 [1.408–2.164]), offering health visitor discussions about PNC (aOR 1.255 [1.046–1.507]), and attending a specialist contraception/sexual health service during the postnatal period (aOR 3.779 [2.510–5.687]) were found to be most significantly associated with these outcomes after adjusting for potential confounders. Conclusions HCP engagement during and after pregnancy was associated with an increased likelihood of accessing PNC care for women in this sample. Expanding the availability of PNC counselling, and the availability of PNC provision in particular, may result in increased uptake of the most effective PNC methods.