What impacts a woman’s contraceptive decisions while breastfeeding?

The qualitative study in BMC Pregnancy and Childbirthunderscores the need to support women who are unable to breastfeed and to educate women about the benefits of contraception for the newborn.

“Women are routinely presented with counseling on breastfeeding and contraception throughout their prenatal and postpartum care, but little is published on patients’ own priorities, desires and experiences of this peripartum counseling,” the authors wrote.

The study comprised individual semi-structured interviews with 20 mothers who gave birth at Montefiore Medical Center in the Bronx—a New York City borough north of Manhattan and Queens. It is the poorest congressional district in the country. Overall, 90% of the women in this study used Medicaid for insurance and 15% were concerned about food security in the past month.

Interviews were conducted between July and October 2017.

All participants received contraceptive counseling, including being offered postpartum long-acting reversible contraception (LARC) on admission to the labor and delivery unit by medical providers, as well as counseling about breastfeeding during their admission.

A full 80% of women also had some counseling about postpartum contraception during their prenatal care.

In addition, all participants had been offered a postplacental intrauterine device (IUD) at the time of admission, and about one-third had received postplacental IUDs.

Interestingly, though, 35% of participants were still undecided about using a contraceptive method postpartum at the time of the interview.

The interview guide explored the timing and content of contraceptive counseling; breastfeeding goals and expectations; reasons for contraceptive choices; and recommendations for counseling.

Three themes emerged from the interviews—the new mothers described contraceptive use as a selfish decision, without benefit to the newborn; women felt pressure to breastfeed and viewed the inability to breastfeed as a personal failure; and medical providers were considered to be more trustworthy for breastfeeding information than contraceptive decisions that relied on anecdotes from friends or family.

Many participants did not consider contraception as a resource for birth spacing, but rather as a way to engage in intercourse while avoiding pregnancy. Most women also did not believe birth control was beneficial for their child. When asked if they would theoretically prioritize contraception or breastfeeding, nearly all women believed breastfeeding was more important because it directly benefited their children.

The majority of mothers also described feeling immense pressure from their medical providers to breastfeed their newborn infants or defined formula upon request. When mothers were unable or unwilling to breastfeed, they experienced feelings of guilt and failure.

During formal counseling from healthcare providers, the women reported being told that breastfeeding was the healthiest option for their baby and often cited that reason for why they chose to breastfeed.

Many women described disregarding their family’s recommendations to use formula and embracing breastfeeding instead after learning the advantages.

“Perhaps the most surprising finding of the study was that the participants did not connect breastfeeding and contraception counseling to each other at all, particularly given their distinctive reactions to the counseling,” wrote the authors.

Study results reinforce the need for the healthcare system to reframe the conversation around birth spacing, emphasizing the benefits to the newborn and maternal health, according to the authors.

Reference

1. Shapiro MP, Avila K, Levi EE. Breastfeeding and contraception counseling: a qualitative study. BMC Pregnancy Childbirth. Published online February 25, 2022. doi.org/10.1186/s12884-022-04451-2