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An analysis comparing two large Auckland maternity services suggests a difference in the ‘quality’ of contraceptive services provided, a paper published in the New Zealand Medical Journal shows.
“Low” rates of new parents left Auckland hospitals having discussed and planned contraceptive use, a study has found.
A survey of 571✓ postpartum patients at Auckland and Counties Manukau hospitals and birthing units was undertaken in 2019 and 2020✓, and published in the New Zealand Medical Journal on Friday.
Postpartum contraception is a “key aspect” of reproductive health, but the researchers said their analysis suggests a “difference in the quality of services provided”.
Lead researcher and registrar Dr Jordon Wimsett said ultimately, the goal is ensuring people have information to decide what’s best for them and their whānau.
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It’s not that everyone needs to use contraceptives, but that they’re supported to make an informed choice, she said.
Pregnancy was an ideal time for these conversations, due to increased contact with health professionals, Wimsett said.
However, more than three-quarters of study respondents at Auckland were unable to recall either an antenatal or postpartum discussion about contraception with a health professional (77%), compared to 39% at Counties Manukau.
Only 16% of patients at Auckland recalled having an antenatal discussion regarding contraception.
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The paper stated that the goal is to enable patients to make contraceptive choices and to obtain their choice immediately after birth, if they wish. But in reality, this differed hospital-to-hospital.
“Maximising the opportunity during pregnancy is really key to being able to provide information in a meaningful way for people,” Wimsett said.
Those who birthed at Counties Manukau were three times more likely to recall a postpartum discussion than those at Auckland, and more likely to recall seeing a hospital contraceptive brochure.
Twice as many Counties patients (31%) left hospital with their chosen method of contraception compared to Auckland (14%).
Over 50% left hospital with no contraceptive plan, or a plan to use a method with a ‘high failure rate’, including natural family planning, withdrawal method, or condoms.
Wimsett said offering patients contraceptive methods before leaving hospital is important, as asking them to return has been identified as a barrier; and delaying starting often means people don’t get their desired, or any, method.
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Changes have been made to national maternity guidelines since the survey was conducted back in 2019/20, so the research team aim to re-do it later in 2023 to see what impacts these have on their findings.
Studies have shown 30-50% of patients don’t attend further visits after leaving hospital, the article stated.
Postpartum contraception also supports people to space out pregnancies – as pregnancy within 12 months increases the risk of complications, including preterm birth, low birthweight, stillbirth and neonatal death.
Certain groups may be at higher risk of unintended pregnancy, particularly those leaving hospital within six hours of giving birth, and non-English speaking patients.
“Careful consideration” needed to be given to how “equitable access” is provided to all, researchers said.
More discussions about contraception during pregnancy, and dedicated nursing staff giving advice after birth would ensure more patients leave hospitals with a contraceptive plan in place, they said.
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The findings show most of the influencers analysed, talked about stopping hormonal contraception methods.
The Ministry of Health published contraceptive guidance in December 2020, with specific mention around postpartum contraception – after the survey was undertaken.
It supports the recommendation that contraception counselling be a routine part of antenatal care, and that health practitioners offer pregnant individuals the opportunity to discuss and document a contraception plan prior to birth.
At the time of the survey, antenatal contraceptive discussions were not a requirement under the Primary Maternity Services Notice 2021. This had also since been updated.
An action plan group had been established at Te Toka Tumai Auckland to prioritise its needs around contraception following the survey, the research stated.
Wimsett said they plan to repeat the survey at the end of 2023 to see what has changed.
Te Whatu Ora has been approached for comment.
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