Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Obstet Gynecol. Aug 10, 2015; 4(3): 52-57
Published online Aug 10, 2015. doi: 10.5317/wjog.v4.i3.52
Urgent need to change clinical practices about postpartum contraception
Crystal Goldsmith, Anita L Nelson
Crystal Goldsmith, Anita L Nelson, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90033, United States
Anita L Nelson, Department of Obstetrics and Gynecology, David Geffen School of Medicine at Harbor-UCLA, Manhattan Beach, CA 90266, United States
Author contributions: Both Goldsmith C and Nelson AL contributed substantially to this work.
Conflict-of-interest statement: Goldsmith C has no conflicts of interest to disclose; Nelson AL has the following conflict of interest disclosures: Research grants from Bayer, Agile; Speakers Bureau honoraria from Actavis, Bayer, Merck, Pfizer, Teva; and Consultant/Advisory Board member for Actavis, Agile, Bayer, ContraMed, Merck, Teva, MicroCHIPS Biotech, and PharmaNest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anita L Nelson, MD, Department of Obstetrics and Gynecology, David Geffen School of Medicine at Harbor-UCLA, 1457 3rd Street, Manhattan Beach, CA 90266, United States. anitanelsonwhc@earthlink.net
Telephone: +1-310-9377226 Fax: +1-310-9371416
Received: January 30, 2015
Peer-review started: January 30, 2015
First decision: March 6, 2015
Revised: March 26, 2015
Accepted: May 8, 2015
Article in press: May 10, 2015
Published online: August 10, 2015
Processing time: 199 Days and 10.2 Hours
Abstract

In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device - has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.

Keywords: Postpartum contraception, Long acting reversible contraception, Subdermal contraceptive implant, Intrauterine device, Unintended pregnancy

Core tip: The postpartum period is an ideal opportunity to initiate highly effective contraception, yet many women leave the hospital without any contraception. Provision of highly effective contraceptives, in particular long acting reversible contraceptives, such as intrauterine devices and contraceptive implants, is safe, desired, effective and cost saving. We review the need for immediate postpartum contraception and recommend changes within the medical system to facilitate this change.