Breastfeeding and postpartum contraception: dual priorities in the immediate postnatal period

In a letter1 published in the July 2016 issue of this journal, the Breastfeeding Network's approach to postpartum contraception was advocated and described as: (i) avoidance of all hormonal contraception in the first 21 days postpartum; (ii) after that, a month's trial of the “mini-pill” to check milk supply is unaffected; and (iii) initiation of hormonal long-acting reversible contraception (LARC) methods (e.g. the subdermal implant), after this and only if breastfeeding is going well. The letter expresses concern among breastfeeding counsellors, based solely on anecdotal reports, regarding “the impact of hormonal contraception on milk supply” (including progestogen-only methods). The Breastfeeding Network's ‘Breastfeeding and Contraception’ factsheet2 asserts that initiation too early after delivery “may interfere with priming of prolactin receptors” and refers to anecdotal reports …