A group of portraits of women A group of portraits of women

Improving the counselling and delivery of postnatal contraception

Dr Anu Ajakaiye, ST3 Doctor O&G

Dr Noreen Haque, ST6 Doctor O&G

Dr Maria Kaloudi, ST5 Doctor O&G

Dr Ruth Roberts, Consultant Obstetrician & Gynaecologist

Betsi Cadwaladr University Health Board



Cartoon image of three women in a line. The first woman is pink in colour whilst the other two are navy.
Risks associated with <12 month interpregnancy interval

Image: Risks associated with short inter-pregnancy interval

Project Aims

  1. Provide formal standardised training to all clinical staff with the help of contraception champions
Headshots of  Contraception Champions
Image: Contraception Champions
Image of Dr Anu Ajakaiye at a training session for the Contraception Champions
Image: Dr Anu Ajakaiye at a training session for the Contraception Champions
  1. Provide staff with tools to ensure safe prescribing of contraception.
Images of contraception files
Image: Contraception files
Image of lapel pin worn by Contraception Champions
Image: Lapel pin worn by Contraception Champions
  1. Provide patients with reliable and more accessible information on contraception choices.
Poster directing patients to up to date information on contraception online
Patient information leaflets advising on post-pregnancy contraception
Screenshot of Contraception in Post natal Period smartphone application, which is still in development

4. Improve the availability of contraception postnatally


Keeping the momentum of the project going. Having a team of 30 enthusiastic champions helped push progress forward and emphasise that this work was intended to be a permanent change and not temporary during the pandemic. A WhatsApp group was set up for troubleshooting, and for sharing updates and statistics.

Difficulties with breast feeding and contraception. All forms of contraception offered at the unit are suitable for women who are breastfeeding. There is some anecdotal evidence that some forms of contraception can potentially reduce the production of breast milk. To ensure that women are given the correct information, this was added to the counselling and proforma.

Insertion of long acting reversible contraception (LARC – contraceptive implant and intrauterine contraception). The insertion of implant requires specific training and a certificate of competence. Unfortunately, we were not able to access this training during the pandemic. Gynaecologists are trained in routine coil insertion. However, inserting a coil immediately after vaginal delivery is not the same as routine insertion and requires training. A programme has been developed and will be implemented soon. In the meantime, women requiring LARC are referred to the sexual health team. They are counselled and all relevant paperwork completed so that women only need one appointment rather than the routine two.

APP. Developing a mobile application requires expertise and resources so we utilised the different skill mix in the team to facilitate this without incurring costs.

Key Outcomes

Increase in uptake of postnatal contraception. Prior to implementing any changes an audit showed that only one woman left the hospital with postnatal contraception in the form of sterilisation. In the month of April 2021 47% of women were discharged with a suitable form of postnatal contraception. A patient survey also showed that 86% of women recalled discussing contraception postnatally compared to 50% in an earlier survey.

Line graph showing contraception uptake from June 2020-April 2021

Feedback from staff training sessions

‘Tammy made it very interesting and easy to understand. It was a very good session and I now feel more confident in being able to help support women make contraceptive choices’

‘In depth information – I thought I was quite knowledgeable but I learnt lots!’

‘I feel much more informed now, lots of interesting information regarding contraindications that I didn’t previously know.

‘Brilliant teaching session, full of information and clear information giving me confidence

‘Informative and clear information relevant to practice. Now feel more confident to discuss in the postnatal period’

Feedback from postnatal patients

‘No improvement needed, very good advice given’

‘I think to just keep as you’re doing its perfect’

‘It’s already good enough’

Next Steps

Roll out the training programme to the other sites within BCUHB – we have presented our work to the Womens Service Board and are having discussions with our Director of Midwifery and Women’s Services on how to implement the same training programme at Ysbyty Gwynedd and Ysbyty Glan Clwyd.

Implementing training for insertion of coils following a vaginal delivery.

Image of MamuU Trainer
Image: ‘MamaU’ Trainer

Our Exemplar Experience

As part of the Bevan Exemplar experience, we felt very supported as a team. The knowledge from the sessions was important in giving us direction in how we developed and evaluated our work.

All round a great experience.



We have a number of poster presentations accepted for National and International Conferences:

  1. Ajakaiye A., Haque N., Kaloudi M., Roberts R. Postnatal Contraception: Using Technology for service development, poster presented at Health Technology Assessment International (HTAi) Virtual Annual Meeting, Virtual, June 2021
  2. Ajakaiye A., Haque N., Kaloudi M., Roberts R. Development of A Training Programme to Improve Counselling and Uptake of Postnatal Contraception, poster presented at 2021 Welsh Annual Audit & Quality Improvement Event, June 2021 Virtually.
  3. Haque N., Ajakaiye A., Kaloudi M. Roberts R. Development & Delivery of A Training Programme To Help Improve Postnatal Contraception Counselling poster presented at RCOG Virtual World Congress 2021, June 2021, Virtual https://rcog2021.ipostersessions.com/default.aspx?s=D6-A7-8C-2C-58-CE-60-21-7C-C7-C5-D7-3F-10-DF-EC
  4. Ajakaiye A., Haque N., Kaloudi M., Roberts R. The use of the Quick Response (QR) code within the NHS, poster presented at RCOG World Congress 2021, June 2021 Virtual. Abstract published in the BJOG RCOG Virtual World Congress – Top 500 abstracts, Quality improvement; 216. https://rcog2021.ipostersessions.com/default.aspx?s=CF-59-DC-23-D4-2B-64-D6-66-F2-20-21-12-4B-CC-8C&guestview=true
  5. Ajakaiye A., Haque N., Kaloudi M., Roberts R. Development of A Training Programme To Improve Counselling and Uptake of Postnatal Contraception, poster presented at RCOG National Trainees Conference 2021, virtual, May 2021. Abstract published in BJOG; The Authors;134;527 https://az659834.vo.msecnd.net/eventsairwesteuprod/production-rcog-public/08965e3cfc98466da981bab7ff41b1bc
  6. Ajakaiye A., Haque N., Kaloudi M., Roberts R. Accessing Surveys and Patient Information via Quick Response (QR) codes to evaluate and improve the delivery of postnatal contraception, poster presentation at RCOG National Trainees Conference 2021, Virtual, May 2021. Abstract published in BJOG; The Authors;117;477 https://az659834.vo.msecnd.net/eventsairwesteuprod/production-rcog-public/9954010ad2814cb481aa03936ddd4fc4
  7. Ajakaiye A., Haque N., Kaloudi M., Roberts R. Improving access to postnatal contraception during COVID pandemic, oral presentation in Welsh Obstetrics and Gynaecology Meeting Spring 2021, Virtual, March 2021 https://wisdom.nhs.wales/welsh-o-g-society/conference/welsh-o-g-society-general-conference-section/welsh-o-g-society-conference-spring-2021/posters-presentations/improving-access-to-postnatal-contraception-n-haque21-pdf/

Thank you to Mr Maraj, Mrs Upadhyay and Fiona Giraud, our senior management team for their support throughout the project.

A special thank you to our champions:

List of contraception champions

Contact Us





Twitter: @Noreen_H


  1. https://www.gov.uk/government/statistics/abortion-statistics-during-the-coronavirus-pandemic-january-to-june-2020/abortion-statistics-for-england-and-wales-during-the-covid-19-pandemic
  2. https://lifecharity.org.uk/wp-content/uploads/2017/06/Interactive-Briefing-Sheet-Abortion-Emotional-Consequences.pdf