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The puerperium offers an excellent opportunity to provide effective contraception. For mothers who are nursing exclusively, ovulation during the first 10 weeks after delivery is unlikely. Nursing, however, is not a reliable method of family planning for women whose infants breastfeed only during the day. Moreover, waiting for first menses involves a risk of pregnancy, because ovulation usually antedates menstruation. Certainly, after the first menses, contraception is essential unless the woman desires pregnancy.

Nearly half of all pregnancies each year in the United States are unintended (Finer, 2016). These may follow contraceptive method failure or stem from lack of contraceptive use. For those seeking contraception, effective options are available (Table 38-1). Among these, estimated failure rates of perfect and typical use during the first year differ widely (Trussell, 2018). Efficacy tiers reflect these failure rates, and implants and intrauterine devices (IUDs) are found in the top tier (Steiner, 2006). They effectively drop unintended pregnancy rates and are considered long-acting reversible contraception (LARC). Clinicians provide counseling on all options and encourage LARC for appropriate candidates (American College of Obstetricians and Gynecologists, 2019d).

TABLE 38-1Contraceptive Failure Rates of Reversible Methods During the First Year and Use Ratesa

No contraceptive method is completely without side effects, but contraception usually poses less risk than pregnancy. However, some disorders or medications can raise the risks of certain contraceptives. The World Health Organization (2015) has provided guidelines for the use of effective reversible contraceptive methods by women with various health conditions. Individual countries have subsequently modified these guidelines. The United States Medical Eligibility Criteria (US MEC) was updated in 2016 by the Centers for Disease ...

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