Contraception: a cornerstone for maternal health

In this blog Dr. Tabassum Firoz, an Assistant Professor at Brown University, explains why contraception access and counseling is essential to improving the maternal and neonatal health throughout the globe.

As the UN General Assembly wrapped up on the eve of World Contraception Day, the global health community — leaders, health professionals, academics, private sector, NGOs and civil society — re-committed to the 2030 global goals. For maternal health, this means striving for a world in which every woman can enjoy a wanted and healthy pregnancy.

However, there are major epidemiological transitions happening around the world that bring about new challenges for women’s health. In many countries, the maternal population is older with higher rates of obesity and chronic medical conditions. For these women, pregnancy is often high-risk and needs careful planning. Safe, effective, and appropriate contraception, therefore, becomes a critical cornerstone of good maternal health.

Studies have found that increasing contraceptive use in low and middle income countries (LMICs) can reduce maternal deaths by 44% by preventing unintended pregnancies. By satisfying the unmet need for contraception, another 104,000 maternal deaths can be prevented per year. Contraception can also improve perinatal outcomes and child survival, mainly by lengthening inter-pregnancy intervals. In LMICs, the risk of prematurity and low birthweight doubles when conception occurs within 6 months of a previous birth, and children born within 2 years of an elder sibling are 60% more likely to die in infancy than those born more than 2 years after their sibling.

Studies have found that increasing contraceptive use in low and middle income countries (LMICs) can reduce maternal deaths by 44% by preventing unintended pregnancies.

Findings from the Guttmacher Institute show that the most common reasons for the unmet need cited by married women are concerns about side effects and health risks, the belief that they have sex too infrequently to warrant use, and the fact they are breastfeeding or have not resumed menstruation since their last birth. Interestingly, only 5% of women stated that the inability to access contraceptives was a reason for non-use.

Pre-conception care including contraception counselling should be integrated into routine maternal health services. Counseling women, especially those with chronic medical conditions, about effective, safe and appropriate contraception is essential in planning a healthy pregnancy.

In some women, delaying pregnancy or spacing pregnancies is necessary for stabilizing the medical condition and optimizing health. This, in turn, can prevent complications during pregnancy, averting maternal morbidity and mortality. Women, for example with common medical conditions like hypertension and diabetes, may also be on medications that are contraindicated in pregnancy and consequently, need effective contraception. Yet we find that in many settings women are not advised on the use of contraceptives or that counselling is inappropriate.

While we need global guidelines on pre-conception care as we do on antenatal and postpartum care, a simple and easy to use resource, especially for colleagues in LMICs, is the WHO Medical Eligibility Criteria for Contraceptive Use.

A core message from discussions at the 2017 UN General Assembly was the breaking down of siloes and building synergies. As we move forward in implementing the global goals, the maternal health, reproductive health and non-communicable disease agendas need to merge so that we can provide the best care to women throughout the lifespan.

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