Use of contraception during the postnatal period and impact of contraception counselling: a Sankey Plot representation and qualitative data from UK doctors        

Background: To avoid unplanned, rapid repeat pregnancies, it is recommended that women use effective contraception from day 21 post- partum. This study presents a novel method for displaying postnatal contraception use over time, analysing data from highly health-literate women.

This is a secondary analysis of a cross-sectional study which compared postnatal contraception use in women over 30 who had successful IVF to those who conceived without fertility treatment. This analysis uses a subset of data: 177 doctors who had conceived spontaneously. Their postnatal contraception use over time is presented using a Sankey plot. Chi-squared or Fisher’s exact tests were used to compare contraception efficacy by socio-demographics and experience of contraception counselling. Qualitative data on quality of counselling were analysed using thematic analysis.

Contraception-efficacy was associated with timing of initiation (p<0.001); 92.3% of sexually-active participants initiating contra- ception before three weeks postpartum used effective or very effective methods. Overall, only 11.6% (17/146) of sexually-active participants used a very effective method as first contraception. Only contraception counselling at the place of birth was associ- ated with initiation of effective or very effective contraception (p=0.041). Analysis of qualitative data on quality of counselling generated three themes: information provision, multi-disciplinary working, and need for self-advocacy.

Use of effective postnatal contraception was low, despite a highly health-literate population. However, the high proportion of women choosing effective contraception before three weeks postpartum indicates acceptability where available. The Sankey plot is an effective visual that could be used to monitor and evaluate postnatal contraception services and interventions. Hosted file BMJSRH Richards Postnatal contraception use and counselling.docx available at https: //authorea.com/users/695648/articles/684236-use-of-contraception-during-the-postnatal- period-and-impact-of-contraception-counselling-a-sankey-plot-representation-and- qualitative-data-from-uk-doctors 1 Posted on 2 Sep 2025 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.169901045.59836089/v2 — This is a preprint and has not been peer-reviewed. Data may be preliminary. Figure 1: Figure 1 Sankey plot demonstrating the number of women who initiated each method of postnatal contraception at each timepoint. LARC = Long-acting reversible contraception, Exc bf = exclusive breastfeeding, Fem steri = female sterilisation, Male steri = male sterilisation. 2