Views of general practitioners on providing contraceptive advice and long-acting reversible contraception at the 6-week postnatal visit: a qualitative study.

BACKGROUND Increased uptake of long-acting reversible contraception (LARC) postpartum could prevent more unintended pregnancies and short inter-birth intervals. General practitioners (GPs) play a pivotal role in providing postpartum contraception at the 6-week postnatal visit. AIM To explore how GPs view their role in delivering postpartum contraception at the 6-week visit and on providing LARC at this time. METHODS In-depth, semi-structured interviews with a purposive sample of 13 GPs in Edinburgh and the surrounding region in Scotland. The interviews were audio recorded, transcribed and thematically analysed. RESULTS All GPs confirmed that contraception was routinely discussed at the postpartum visit, although this was usually the last item covered. Most felt that while 6-weeks postpartum was adequate for most women to commence contraception, it was often too late for young mothers (aged under 20 years) or women from deprived areas. GPs provided prescriptions for oral contraception at this visit, but insertion of a contraceptive implant required a further appointment. For intrauterine contraception, women typically required two additional visits to the GP (for counselling and then insertion) or were referred to a local sexual health service. Some GPs saw their role as the main provider of postpartum contraception, whereas others felt they complemented the actions of midwives and health visitors. CONCLUSIONS This study demonstrated that although contraception is discussed at a routine 6-week postpartum visit with a GP, there are delays for women wishing to commence LARC that create scope for unintended pregnancy. Strategies to facilitate access to LARC postpartum should be explored.