New approaches could lead to more equitable postnatal contraceptive advice

Becoming pregnant again shortly after giving birth can pose risks to both the woman and the baby. A new study involving Jönköping University (JU), amongst others, shows that new approaches to contraceptive advice can help more women choose effective contraception. At the same time, the study shows that regional differences affect the ability to provide equitable postnatal care.

Previous research shows that foreign-born women more often face barriers when accessing healthcare and are less likely to receive support regarding contraceptive methods after giving birth. For example, they are less frequently offered advice or prescriptions. Limited language skills and difficulties navigating the healthcare system may be some of the reasons for this.

In the study, midwives at 28 midwifery clinics in the Stockholm Region, the Västra Götaland Region and Region Jönköping County participated in training and improvement initiatives alongside foreign-born women. They further developed and tested new working methods, such as information materials on contraceptive methods and procedures for providing advice on contraceptive methods after childbirth.

“We wanted to develop the counselling service in collaboration with the women concerned. This gave us a better understanding of the barriers that exist and how the counselling service can be designed so that more women can benefit from it,” says Helena Kilander, associate professor and researcher at the Department of Quality Improvement and Leadership at the School of Health and Welfare at JU.

In total, around 14,000 women were followed up at their postnatal check-up 16 weeks after giving birth. The aim was to investigate whether the new approach could strengthen the counselling service and improve access to safe contraceptive methods after childbirth for women born abroad.

The effect varied between different groups

The study shows that the proportion of women who chose an effective method of contraception rose from around 45 per cent to 49 per cent at the clinics that adopted the new approach. The increase was seen primarily among women born in Sweden, whilst the change was small among foreign-born women.

The researchers also observed clear differences between regions. In Region Jönköping County, the proportion of foreign-born women choosing an effective method of contraception increased, which was not the case in the other regions.

The researchers believe this suggests that midwives face different conditions when it comes to implementing changes and providing women with the same level of support.

“The results show that it is not enough to simply introduce new working methods to achieve equitable care. Differences in conditions at clinics – such as the ability to extend appointment times and tailor visits to women’s needs – can make a significant difference,” says Elin Larsson, associate professor and researcher at the Department of Global Public Health at Karolinska Institute.

The researchers will now investigate why the approach worked better in some regions than in others. They will also launch a new study to examine organizational barriers that may affect women’s access to contraception.