FHI - August 31, 1997

Contraception after Pregnancy -- August 31, 1997

RESEARCH TRIANGLE PARK, NC -- After a woman gives birth, she faces many challenging tasks; caring for a newborn and ensuring her own recovery among them. Many postpartum women also want to space or limit further childbearing, in order to protect their own health and that of their infants, but may not be well informed about their family planning options.

An important aspect of postpartum care is a woman's need to begin contraception when fertility returns, and knowing about specific contraceptive requirements, experts say in the current issue of Network, a quarterly publication from Family Health International. IUDs, barrier methods and hormonal contraceptives are all appropriate for the postpartum period, but advice about their use may be different than for regular use, especially for breastfeeding women. Providers must be aware of restrictions and inform clients of them in order to ensure effective contraceptive coverage and protect the breastfeeding infant.

For example, combined hormonal methods (those that contain estrogen and progestin), including oral contraceptives and certain injectables, should normally be delayed six months for breastfeeding women, since estrogen can diminish the amount of breastmilk.

An excellent contraceptive option for postpartum women is the lactational amenorrhea method (LAM), a form of breastfeeding that provides natural contraception that is at least 98 percent effective during the six months after delivery if used correctly. Correct use means that a woman's menses have not resumed, that she is fully or nearly fully breastfeeding, and that her baby is less than six months old. When any of these three aspects end, a woman should begin using another method to assure reliable contraception.

Reproductive health experts from several international organizations listed other key issues involving good health care after pregnancy:

For women who have undergone abortion or miscarriage, fertility returns quickly (as early as 14 days). Therefore, it is important that health providers offer postabortion clients timely family planning services so that they may prevent a subsequent unplanned pregnancy. Also, the reproductive goals of a postabortion woman, who may want to prevent another unplanned pregnancy, may differ substantially from a postpartum woman, who may be more interested in spacing births.
While postpregnancy services traditionally focus on women and children, involving men can also be useful. Postpartum contact with male partners offers an opportunity to educate men about the value of spacing children, an important factor since a man often has substantial influence in a couple's decision to use family planning. Postabortion counseling for men can help prevent repeat abortions by stressing the need for consistent use of reliable contraception to prevent unwanted pregnancy. Worldwide, some 30 percent of couples depend on contraceptive methods that require men's active cooperation or participation, such as condoms, vasectomy, withdrawal or periodic abstinence.
Strategies to prevent maternal deaths or morbidities tend to focus on the prenatal and delivery periods, yet a recent analysis concluded that the postpartum period is also critical. "In both developing countries and the United States, more than 60 percent of maternal deaths occurred in the postpartum period," reported the analysis of nine studies published since 1985. Hemorrhage, pregnancy-induced hypertension complications, and obstetric infection were the most common causes of postpartum death. "We need to pay much more attention to the postpartum period," says Dr. Judith Fortney, FHI's corporate director for scientific affairs and an expert in maternal health. It is important for family members to realize that emergency care may be necessary after delivery, she says. "A mother can bleed to death slowly. She could have high fevers indicating an infection. Lactation might not be well established, and the baby can become dehydrated."

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Contraception after Pregnancy -- August 31, 1997