Case study 1 | My Site

Case study 1 - Accessing post-natal contraception

The provision of contraceptive counselling and methods should form a key part of holistic post-pregnancy healthcare; however, many women struggle to access contraception after childbirth, abortion and miscarriage, in part due to commissioning challenges. In fact, our 2024 report found that no respondents accessed contraception at post-natal services, and only 1% at abortion services.

While not all women may want contraception immediately after pregnancy, it is vital those that do are supported in choosing the right method. Post-pregnancy healthcare should routinely discuss contraception, and NICE guidelines stipulate that “women should be offered a choice of all contraceptive methods within seven days of delivery” as fertility can return quickly after childbirth. Moreover, shorter intervals between pregnancies are associated with risk of poorer outcomes for both mothers and babies.

Anon's story

Anon moved to the UK from Portugal ten years ago, without English as a first language. She was using the pill when she first arrived and found it easy to keep accessing her preferred option from the NHS, with the option to have an interpreter.

Preparing to give birth to her second child, Anon was keen to explore switching to the copper coil. However, in contrast to her first pregnancy in Portugal, she struggled to have conversations about her post-pregnancy contraceptive choices with either maternity services or her GP. She was told to call a sexual health clinic (SHC) to have a coil fitted but had not previously been aware that SHCs were an option for accessing contraception and received little information about where or how to access them. In Portugal, SHCs do not exist as a separate part of the system, which made navigating this unfamiliar structure in the UK more difficult. Anon waited three months after giving birth to have her coil fitted.

After 5 years on the copper coil, Anon decided to switch to the hormonal coil, and again sought to access this via a SHC. The first SHC Anon tried did not answer their phones, leading her to look for an appointment in two alternative boroughs. The first of these alternative SHCs did not have availability for an initial telephone consultation for another six weeks – when she missed the call, she was not able to call back and was asked to wait another six weeks to reschedule. Anon then tried a second alternative borough, where she was able to have her new coil fitted.

The difficulties Anon faced were not due to English being her second language, nor discomfort with discussing sexual health, but rather a lack of available information about the UK healthcare system and the absence of guidance on how and where to access contraception from clinicians.

Anon recommends that contraception providers take steps to explain both the available contraceptive methods and the range of providers to women, ensuring they have all the information needed to make informed decisions, especially in post-pregnancy settings. Anon suggested that more should be done to support migrant women to navigate the healthcare system, as factors like language barriers, lack of financial means, and the absence of a support network to help them access services can be inhibitive.