Influence of culture, religion and experience on the decision of Pakistani women in Lothian, Scotland to use postnatal contraception: a qualitative study.

INTRODUCTION: Evidence suggests that Pakistani women may experience difficulty accessing postnatal contraceptive (PNC) services. The study aimed to identify experience and decision-making around PNC provision for Pakistani women in Lothian, and to explore the views and experience of maternity staff who provide PNC counselling. METHODS: Qualitative research including focus groups and 1:1 semi-structured interviews with women and staff. Participants were first- and second-generation Pakistani women with a child/children aged up to 5 years, or pregnant; community and hospital midwives, obstetric doctors who counsel or provide PNC. Data were coded and categorised using QSR NVIVO10. Inductive thematic analysis was carried out. RESULTS: Women were receptive to discussion of contraception, including antenatally, and welcomed translated information. Some said the decision on PNC was theirs or made jointly with their husband; however, they acknowledged that in some marriages the husband will take the decision. Women stated they may face family expectation to have a baby early in marriage. Language was identified as a challenge by maternity staff, who utilised translation services to ensure women received the information they needed on contraception. CONCLUSIONS: Pakistani women value antenatal discussion about PNC. Maternity staff have an important role in providing quality information on contraception and should be supported with translated resources in a range of formats. Most importantly, staff should adopt a tailored approach to identify the individual woman's needs and preferences.

Developing the role of midwives as 'contraceptive champions' to support early access to effective postnatal contraception for women.

OBJECTIVE: To evaluate the acceptability of the new contraceptive champion role to the first hospital and community midwives in NHS Lothian trained in this role. DESIGN: Health service evaluation. POPULATION: Hospital and community midwives trained as contraceptive champions, NHS Lothian, Scotland, UK. METHODS: Qualitative research: 1:1 semi-structured interviews (baseline and follow-up) with five contraceptive champions. MAIN OUTCOME MEASURE: Qualitative data on views of the new contraceptive champions on the first 6 months of the role. RESULTS: All contraceptive champions stated increased confidence in their knowledge of postnatal contraception. They reported that women had not questioned the role of midwives in inserting contraceptive implants postnatally in hospital and at home. Midwife colleagues and hospital doctors had been supportive. CONCLUSION: The new role of contraceptive champion is reported by midwives to have been well received in its first year by women, the midwives themselves and their healthcare colleagues.

Antenatal contraception counselling and provision of contraception after delivery for first-time young mothers enrolled with a Family Nurse Partnership programme.

OBJECTIVE: To evaluate antenatal contraceptive counselling and provision of postpartum contraception on contraceptive choices of first-time teenage mothers enrolled with a Family Nurse Partnership (FNP) programme. DESIGN: Health service research evaluation. POPULATION: Cohort of FNP clients (n=195), Scotland, UK. METHODS: Antenatal contraceptive counselling and provision of chosen method from the hospital. Evaluation consisted of (i) self-administered questionnaires of FNP clients and (ii) interviews with FNP clients and FNP nurses. MAIN OUTCOME MEASURES: FNP client views on intervention. Secondary outcomes included: contraceptive choice antenatally, at day 10 postpartum, 3 and 12 months after delivery, and views of FNP nurses on the intervention. RESULTS: Antenatal questionnaires were completed by 118/195 (61%) clients. 96/118 (81%) agreed that it was very or quite helpful to receive antenatal contraceptive counselling and 80/118 (68%) were planning to use a long-acting reversible method of contraception (LARC). 97/121 (80%) wished to receive contraception before leaving the hospital. 104/195 (53%) completed a questionnaire at day 10 postpartum, of which 33 (32%) indicated that they had received contraception from the hospital. FNP nurses expressed frustration when contraception was not provided; this was usually attributed to the busy workload of the maternity department. CONCLUSIONS: Antenatal contraceptive counselling was appreciated by FNP clients and they expressed a preference for contraception provision following delivery. Over two-thirds planned to use a LARC method but many did not receive this from the hospital. Further interventions are required to ensure that the provision of postpartum contraception is prioritised for this group of young women.