Evidence on how contraception is currently managed in the first year after pregnancy in England is scarce. Women may struggle to access their preferred and most effective means of contraception as they need to care for a new-born. This may lead to unwanted or unplanned pregnancies, which carry a higher risk of complications for both mothers and babies. Therefore, this project aims to (1) understand whether and when women are being prescribed contraception by their GPs in the first year after giving birth; (2) explore whether there are differences between women of different ages, socioeconomic status, and ethnicity; and (3) investigate whether women who are prescribed contraception by their GPs are less likely to become pregnant again within a year. The findings of this study will help understanding whether contraception should be given to all women before they leave the hospital after giving birth.
Evidence on how contraception is currently managed in the first year after pregnancy in England is scarce. Women may lack access to their preferred and most effective means of contraception due to difficulty in conciliating looking after their reproductive health and caring for a new-born. This may result in unwanted or unplanned pregnancies, which carry a higher risk of complications for both mothers and babies. Therefore, this project aims to (1) describe how contraception is being managed by primary care in the first year after pregnancy in England, (2) explore differences in contraception management according to age, socioeconomic status, and ethnicity, and (3) estimate the association between prescription of contraception and risk of a second pregnancy within the first year after the index pregnancy.
This cohort study will include women with a recorded pregnancy in the CPRD pregnancy register between 2000 and 2021. Women will be followed up for 12 months after the date of delivery. The proportion of women with contraception in their primary care records during the study period will be calculated, as well as the mean time to the first prescription of contraception. The proportion of women with a second pregnancy within a year of the index pregnancy will be calculated overall and for specific pregnancy outcomes, such as live birth, stillbirth, preterm birth, termination, and miscarriage. Subgroup analyses will be carried out according to age, deprivation, and ethnicity. Multivariable Cox regression models will be used to estimate the association between prescription of contraception and risk of a second pregnancy during the study period.
Understanding gaps and inequalities in contraception management after pregnancy will inform the development of strategies to improve contraception in this critical period and prevent unplanned pregnancies and their adverse consequences for mothers and babies.
Primary outcomes:
- Proportion of women who are prescribed any type of contraception in the first year after pregnancy
- Time to first prescription of contraception in the first year after pregnancy.
Secondary outcomes:
- Proportion of women with an interpregnancy interval under 12 months (i.e., a secondary pregnancy within a year of the index pregnancy)
Incidence of different pregnancy outcomes for pregnancies with an inter-pregnancy interval under 12 months, including live birth (pre-term and term), stillbirth, miscarriage, and termination of pregnancy
- Type of contraception provided (long-acting regional contraception, progesterone-only pill, combined oral contraceptive pill, depot).
Edward Mullins - Chief Investigator - Imperial College London
Edward Mullins - Corresponding Applicant - Imperial College London
Ana-Catarina Pinho-Gomes - Collaborator - University College London ( UCL )
Patient Level Index of Multiple Deprivation;CPRD Aurum Pregnancy Register