Title: Overcoming barriers to the uptake of postnatal contraception: a mixed-methods study
Funder: Department of Health and Social Care

Abstract: Research question: How can women and health professionals be supported to access and deliver better contraception care during the postnatal period? Background Ensuring that women have access to appropriate contraception options in the eight weeks after giving birth (the postnatal period, as defined by NICE) is essential in preventing unplanned pregnancies and the biopsychosocial harms that may accompany them. However, we know that many recently pregnant women are not appraised of their contraceptive options, and that inconsistent provision represents a health inequality with some groups less likely to receive comprehensive postnatal care than others. As a neglected area of research, there is not currently a consensus approach to effectively delivering postnatal contraception services and to overcoming the barriers that might stand in their way.Aim and objectives Aim: To determine a consensus approach to the effective delivery of postnatal contraception services as part of an iterative intervention development process.Objectives: To review the literature on interventions and strategies intended to expand the uptake of postnatal contraception, examining measures of success and descriptions of barriers and facilitators to their successful implementation. To engage a diverse cohort of women and professionals to explore the barriers that prevent these interventions and strategies from being effective. To integrate the learning from these work streams to develop recommendations on models of care for postpartum women, and to inform the development of an intervention protocol.Methods This mixed-methods study will comprise four work packages. Work Package 1 (WP1) will deliver a mixed methods systematic review and meta-analysis that will comprehensively synthesise what is currently known about strategies, interventions and care models intended to improve access to, and uptake of, postnatal contraception. Work Package 2 (WP2) will undertake a qualitative exploration of a diverse range of women's and healthcare staff perspectives on barriers and facilitators to the use of successful strategies, using a Constructivist Grounded Theory approach with themes subsequently mapped against the Theoretical Domains Framework. Work Package 3 (WP3) will integrate the research findings and these will be shared with an expert panel of professionals and women who will be asked to agree on a consensus approach to the provision of postnatal contraception using a DELPHI-method exercise. Work Package 4 (WP4) will coproduce an intervention protocol, based on the findings of the previous work packages, and in collaboration with public and professional stakeholders, that will be piloted and evaluated in postdoctoral work. Timelines for delivery of research WP1: completion of systematic review (months 1-9) WP2: design and recruitment (months 1-11), data collection (months 12-15), analysis (months 12-19) WP3: mixed-methods synthesis (months 20-22), consensus workshops (months 23-25), analysis (months 25-26) WP4: co-design of intervention protocol (months 27-30), thesis and publications write-up and dissemination (months 31-36)Anticipated impact and dissemination This research will be shared with policymakers, commissioners and providers, offering stakeholders an evidence-based approach to the provision of postnatal contraception that overcomes patient and provider barriers and that can be deployed widely, and will raise awareness of the importance of postnatal contraception among the public.

Lay abstract: Background Unplanned pregnancies can be prevented when women have access to safe and reliable contraception. Various healthcare professionals have contact with new mothers in the weeks after they deliver their babies (the postnatal period) - midwives, doctors, health visitors, and nurses. Although not all women who have recently had a baby will want to begin using contraception straightaway, it is important that the different options are explained and that women are supported to access the contraceptive that is right for them. Becoming pregnant again shortly after completing a pregnancy can be harmful for mothers and babies. However, we know that many women aren't told about their contraceptive options after they've had a baby. We also know that young mothers and mothers from poorer backgrounds are less likely to access postnatal care, including contraception care. Aim of the research This research will try to find out why some women who have a baby are not offered, or do not feel able to access, contraception in the postnatal period. It will look at how health services have tried to improve access to postnatal contraception in different settings. I will speak to women and healthcare professionals to understand their views and experiences of accessing contraception. I will ask women what contraceptive support they want after they have had a baby. Design and methods This study will involve using different research techniques to look at barriers and enablers to postnatal contraception and will bring the findings together to determine the best approach to providing postnatal contraception: Work package 1 will gather together research that has already been carried out on barriers and enablers to postnatal contraception and on approaches that improve women's access to it, and combine the findings to provide an overview of what is already known about the topic (a systematic review). Work package 2 will involve speaking to women from diverse backgrounds who have had a baby in the last few years to hear about their experiences of accessing postnatal contraception care. It will also involve speaking to healthcare professionals and exploring how opportunities to provide a better postnatal contraception service might be implemented more widely (qualitative interviews/focus groups). Work package 3 will bring together women and healthcare staff to share the findings of work packages one and two, and to identify preferred approaches to improving access to postnatal contraception in light of what the research has found. It will use a research technique called DELPHI method to find agreement (consensus) among the group. Work package 4 will involve co-designing a new approach to postnatal contraception based on the findings of the previous three work packages (intervention development). Patient/service user and public involvement Women have helped to develop this proposal and are core to this research. The views that they have shared and will share will shape the findings of work packages two and three and will be vital in developing a new approach to postnatal contraception care in work package four. Service user representatives (women) will also be asked to share their views on the research more generally by being part of a lay advisory group, that will help to make sure that patient and public perspectives inform every aspect of the project. Dissemination The findings of this research will be shared widely in a range of formats -h; with the public, with healthcare professionals, with organisations like the NHS and local authorities that provide and pay for services, and with government departments like the Department of Health and Social Care that set health policy for England.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: REPRODUCTIVE HEALTH AND CHILDBIRTH