LEAH MBABAZI: Birth Control After Childbirth; How Soon is too Soon?

Have you just had a baby? Birth control could be the very last thing on your mind, but preparing for contraception is an important part of your antenatal and postnatal care. 

After childbirth, menstrual periods can return any time from six weeks to three months depending on whether the woman exclusively breastfeeds, formula feeds, or uses a mix of both. However, it is possible to get pregnant before having a period because one can become fertile unknowingly. Research shows that women who do not breastfeed can ovulate as early as a month after giving birth yet more than 50% of all women have sexual activity within 6 weeks of having a baby. That is why it’s important to have a birth control plan if one is not ready for another child. 

Studies show that approximately 95% of women who are within their first year of postpartum (post-childbirth) want to avoid pregnancy in the next 2 years, but 70% of them do not use contraception. Yet pregnancies in the postpartum period pose the greatest risk for women and their infants. Thus post-partum contraception is crucial for ensuring the health and well-being of women and their babies.  The World Health Organization (WHO) recommends that women in postpartum and their partners should be provided with choices of effective contraceptive methods, to prevent unintended pregnancies during their first 12 months post-childbirth. It also recommends that women start planning for birth control (contraception) around the time of their last antenatal visit and start using contraception from three weeks after childbirth.

The choice of contraception after giving birth depends on whether and how often the woman is breastfeeding and how suitable the various methods are for her. For some women, breastfeeding can be a birth control method by delaying the return of menstrual periods. However, it only works if done exclusively, frequently, and regularly (at most four hours between feeds). 

Breastfeeding women should avoid any contraception containing estrogen such as the combined oral pill because it may reduce the supply of breastmilk. Nevertheless, there is still plenty of other contraception choices such as condoms, injection, implants, intrauterine device (IUD), and progesterone-only pills. There is no one-size-fits-all approach to birth control after childbirth and no method is 100% effective. Therefore, to decide what contraceptive method is best suitable after giving birth, ask the doctor, midwife, or nurse about: the methods available, how soon to start them, how they work, their effectiveness, and possible side effects of each method. Lastly, it is very important to make sure the woman is not pregnant before starting contraception.

Author: Leah Mbabazi (BSN, MPH). Clinical Research Coordinator at infectious diseases institute, Makerere University.