Contraception after pregnancy and abortion

Synopsis

Prevent unintended rapid repeat pregnancy by offering method choice antenatally and immediately after birth or abortion using exact postpartum, breastfeeding and insertion rules.

Discuss contraception during pregnancy or abortion care and provide the chosen method before discharge whenever clinically possible; fertility can return before the next period.
After childbirth, contraception is needed from day 21 unless the patient is less than six months postpartum, remains amenorrhoeic and is fully or nearly fully breastfeeding at effective frequency.
Insert an IUD immediately to 48 hours postpartum or from four weeks; the 48-hour to under-four-week interval is UKMEC 3, and postpartum sepsis is category 4.

Key red flags

Contraception is required from day 21 after childbirth unless all lactational amenorrhoea criteria are met: under six months, amenorrhoeic and fully or nearly fully breastfeeding.

Postpartum IUD insertion is UKMEC 1 at 0–48 hours, category 3 from 48 hours to under four weeks, category 1 from four weeks and category 4 with postpartum sepsis.

Breastfeeding CHC is UKMEC 4 before six weeks, category 2 from six weeks to under six months and category 1 from six months on feeding status alone.

Implant and POP are UKMEC 1 while breastfeeding in the first six weeks; DMPA is category 2, so each progestogen method retains its own classification.

After abortion, immediate contraception is usually possible; IUD insertion is category 1 after first-trimester abortion, category 2 after second-trimester abortion and category 4 with post-abortion sepsis.

Day-21 transition

Unprotected sex from day 21 postpartum can create pregnancy risk unless every LAM criterion remains satisfied.

Postpartum sepsis

Endometritis or puerperal sepsis makes immediate intrauterine insertion category 4 and needs treatment.

Investigation priorities

Pregnancy and abortion chronologyFirst step

Establish delivery or abortion date, gestation, complications and current pregnancy risk.

Management branches

Antenatal pathwayChoose and document before birth

A pregnant person wants to avoid or space another pregnancy.

Discuss reproductive goals, breastfeeding plans, effectiveness, bleeding, reversibility and procedure preferences antenatally.
Arrange post-placental IUD, immediate implant, POP or DMPA access and document who will provide it.

Key medicines

Immediate postpartum progestogen-only contraceptionStart the chosen POP daily, insert the implant once or give DMPA at the product dose after birth; apply formulation-specific backup and UKMEC rules.During breastfeeding under six weeks, implant and POP are category 1 while DMPA is category 2; review bleeding, interactions and future fertility plans.

Postpartum combined hormonal contraceptionBegin pill, patch or ring only after the exact breastfeeding, postpartum interval and VTE-risk category makes CHC eligible, then use product-specific initiation instructions.Breastfeeding before six weeks is category 4; non-breastfeeding timing and additional VTE factors create separate categories before six weeks.

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