11.1 What is postpartum and post-abortion family planning?
Postpartum family planning is the initiation and use of family planning methods in the first six weeks following delivery (Figure 11.1). The aim is to prevent unintended pregnancy, particularly soon after childbirth, when another pregnancy could be harmful to the health of the mother or breastfeeding baby.
In Study Session 3 of the Labour and Delivery Care Module you learnt that after the delivery of the placenta, the inhibiting effects of oestrogen and progesterone are removed. So the levels of follicle-stimulating hormone and luteinizing hormone gradually rise, and ovarian functions begin again. Due to these effects, the menstrual cycle in non-breastfeeding mothers will start within four to six weeks of delivery (on average 45 days). However, if the mother is exclusively breastfeeding, the menstrual cycle may not return until six months after delivery.
Why is family planning important during the postpartum period?
When the menstrual cycle returns, there is a risk of pregnancy that could influence the health of the mother and infant.
Post-abortion family planning is the initiation and use of family planning methods immediately after, and within 48 hours of an abortion, before fertility returns. In most women fertility returns on average about two weeks after an abortion; however, ovulation can occur as early as 11 days post-abortion. Part of your role is to help prevent unintended pregnancies in women who do not want to be pregnant again, or for whom pregnancy may be dangerous.
You can begin post-abortion family planning immediately after post-abortion care for those women who wish to prevent pregnancy. Be aware that following an abortion in the first trimester, or first three months of pregnancy, a woman’s fertility usually resumes within two weeks. However, following an abortion in the second trimester, a woman’s fertility usually returns more slowly, within four weeks.
Based on the above descriptions of the postpartum and post-abortion periods, are the principles and guidelines of family planning the same for both?
Some health providers incorrectly think that the guidelines for postpartum family planning also apply to post-abortion family planning. There are differences though. For example, special concerns for postpartum family planning related to breastfeeding do not apply to post-abortion women. As a result, women are often not offered family planning methods after an abortion that would be both appropriate and acceptable to them.