11.5  Postpartum and post-abortion family planning options

11.5.1  Family planning options postpartum

In Ethiopia, more than 90% of all mothers breastfeed their infants for some period of time. In this case, the impact of contraceptive methods on breastfeeding, breastmilk, and infant health is of some concern.

Effective breastfeeding should be encouraged for the benefit of the mother, and the health of the infant. Here are three general guidelines you should follow.

  • Encourage women to exclusively breastfeed for the first six months.
  • Ensure their chosen contraceptive method will not adversely affect breastfeeding or the health of the infant.
  • Be certain that breastfeeding is not discontinued in order to start a contraceptive method.

For breastfeeding women, non-hormonal methods are the best choice and can safely be used. They do not interfere with a woman’s ability to breastfeed, or the quality and quantity of breastmilk and there is no adverse effect on infant growth and development. From your previous sessions in this module, you have learnt that non-hormonal methods include lactation amenorrhoea method (LAM), male or female condoms, spermicides, diaphragms, IUCDs, male or female voluntary surgical contraception (VSC), and natural family planning methods.

Progestin-only oral contraceptive methods are the next best choice, and are considered a suitable method for breastfeeding women six weeks after childbirth. This method has been shown not to affect breastmilk secretion and breastfeeding or infant growth and development. Options include progestin-only injectables, progestin-only pills, and implants put under the skin.

It is recommended that progestin-only methods be provided after the first six weeks postpartum. However, some find it more convenient to begin these methods immediately after delivery, since no adverse effects on the infant or breastfeeding have been observed.

Combined oral contraceptives are less frequently recommended for breastfeeding mothers, because they are known to decrease breastmilk secretion by inhibiting the secretion of prolactin. However, it is an option if the mother is no longer breastfeeding, or breastfeeding less frequently six months after childbirth. These methods include combined oral contraceptives and combined injectable contraceptives (Mesigyna and Cyclofem). See Table 11.1 for a summary of options for breastfeeding women.

Table 11.1  Summary of family planning options for breastfeeding women.
Best choice: non-hormonal methodsAlternative choice: progestin-only methodsLess preferable: combined oestrogen-progestin methods
  • Lactation menorrhea method (LAM)
  • Diaphragm
  • Male and female condoms
  • Spermicides
  • IUCD
  • Male and female sterilisation
  • Natural Family Planning (NFP).
  • Progestin-only pills
  • Injectables (DMPA, NET-EN)
  • Implants (Jadelle, Implanon).
  • Combined oral contraceptive pills (COCs)
  • Monthly injectables (Mesigyna, Cyclofem).

11.4  Postpartum and post-abortion counselling

11.5.2  Family planning options post-abortion