Title: Postpartum family planning
Course: Level 3 - Family Planning > Section: Overview of postpartum, post-abortion and permanent family planning methods

The postpartum period is a critical time for appropriate health interventions, as the majority of maternal and infant deaths and illness occur during this time. Women in their first year postpartum and their families are a priority group to reach with family planning information and services. For this reason, it is important to systematically integrate family planning services with maternal, newborn, and infant services.

Return to fertility after childbirth

The timing of a woman's return to fertility after childbirth is difficult to predict and depends on her circumstances and breastfeeding schedule. It is important for postpartum women to initiate the use of a family planning method before their fertility returns in order to avoid an unintended or mistimed pregnancy.

Breastfeeding women

For postpartum women who breastfeed exclusively (breastfeed often, on demand, 8 to 10 times a day, without giving any other liquids or foods to the baby), have no menses, and have an infant less than 6 months of age-which are the 3 criteria for the lactational amenorrhea method, or LAM there is a 1% risk of conception. Once 1 of these three criteria is no longer present, the woman is no longer protected from pregnancy.

Non-breastfeeding women

On average, women who do not breastfeed ovulate by the 45th day after childbirth, and possibly as soon as the 28th day after delivery. Fertility begins before the return of menses in 2 out of 3 women.

Women who are partially breastfeeding

Women who are partially breastfeeding are not using LAM and, therefore, are not protected from pregnancy. Return to fertility may occur before resumption of menses.

Postpartum family planning counselling messages

- Promote optimum health by advising exclusive breastfeeding and using LAM, which is 99% effective when used correctly.
- Discuss health benefits to the mother and baby of waiting at least 24 months before trying to become pregnant again.
- Discuss return to sexual activity and provide information about return to fertility.

A woman who is not exclusively breastfeeding can become pregnant as soon as 4 to 6 weeks after childbirth. An exclusively breastfeeding mother may become pregnant as soon as six months postpartum. Advise that, for maximum protection; a woman should not wait until the return of monthly bleeding to start a contraceptive method, but instead, she should start as soon as medical guidance allows. So offering and discussing family planning options for postpartum women is important; including long-term and permanent methods according to the client's wishes.

When can postpartum women start family planning methods?

When a woman should and can start family planning methods after childbirth depends on her breastfeeding status, method of choice and reproductive goals

Summary of the Earliest Times a Client May Start Family Planning After Childbirth

Family planning method | Exclusive breastfeeding | Partially breast feeding or not breast feeding
Lactational Amenorrhea method | Immediately | Not applicable because it cannot prevent pregnancy
Male or female condoms | Immediately | Immediately
Progestin-only pills | 6 weeks after childbirth | Immediately if not breastfeeding six weeks after childbirth if partially breastfeeding
Progestin-only injectables
Implants
Combined oral contraceptives(COCs) | 6 months after childbirth | 21 days after childbirth if not breastfeeding six months after childbirth if partially breastfeeding
Copper-bearing IUCD | Within 48 hours, otherwise wait four weeks | Within 48 hours, otherwise, wait four weeks