The effect of oral contraceptive acceptance on fertility in the postpartum period

Abstract

In Bangladesh where postpartum amenorrhea is long and contraceptive pill continuation rates are low the result of introducing oral contraception during the period of post partum amenorrhea is actually to decrease the interval to the next pregnancy. In 121 matched pairs from rural Matlab thana in 1979-1980 fertility is increased relative to that of a matched group of non-acceptors. The earlier return to fertility of acceptors persists even though there is a higher acceptance rate in the early postpartum period and women who accept at this time have higher continuation rates than those who accepted later. There is a possibility that a few of the women who were later acceptors may have conceived prior to initiating contraception and discontinued as soon as they became aware of the pregnancy. On the other hand the chance of conception which has been shown to increase in the later months of lactational amenorrhea may be further heightened by a short duration of oral contraceptive use. 1 model shows that the most important variable in determining the delay to the next pregnancy is the contraceptive continuation rate. For the group of women who continued use for more than 6 months the median time to the next pregnancy was close to that of the non-acceptor matched group. This implies that unless program efforts can achieve average continuation of at least 9 months it would be better not to provide oral contraception during the period of postpartum amenorrhea. This position is reinforced by our knowledge of the adverse effects which hormonal contraception particularly combined preparations have on the quantity of milk produced by the lactating postpartum mother.