Postpartum return of fertility

A.             Return of Ovulation in postpartum period :

Postpartum Return of ovulation release of eggs varies from woman to woman and as stated earlier, the timing of first ovulation in postpartum period primarly depend on frequency of breastfeeding and duration of breastfeeding. In nonlactating mothers ‘ovulation’ can rare occationally resume as early as twently one day after childbirth. Many nonlactating women do ovulate by sixty days postpartum.

By contrast who breastfeed as per international norm in them resumption of ovulation frequently precede the onset of menstruation. So the general belief of commencing contraceptive after resumption of menstrual period does not hold good. Unfortunately, many Indian women still believe that unless menstruation returns till then she is protected from pregnancy. This false sense of security is a common cause of unintended pregnancy in postpartum period.

B.              Return of menstruation and return of fertility :

S. long we have discussed about role of breastfeeding in preventing pregnancy. We now focus on the spatial relation of return of menstruation in postpartum period and possibility of fresh pregnancy.

Postpartum amenorrhoea i.e. nonoccurrence of menstruation is the interval between the birth of a child and resumption of menstruation. It is the period following childbirth during which a woman becomes temporarily and involuntarily infecund.

Admittedly the duration and frequency of breastfeeding primarily govern the length of postpartum amenorrhoea but there are other hitherto unknown factors as well. As breastfeeding practice varies in different parts of India so also the duration of postpartum amenorrhoea (nonoccurrence of menstruation). However the usual trend of amenorrhoea amongst India women is discussed below.

Postpartum initiation of sexual intercourse :

As this chapter is dedicated to fix up the time of initiation contraceptives in postpartum period it will be pertinent to highlight some aspects of human sexual behavior in postpartum period.

Postpartum coital behavior varies greatly in different parts of globe. Initiation of sexual activity depends on factors like socio cultural taboo, health of the partners, nature of delivery (natural or caesarean) whether the women stays at her father’s residence and obviously the educational status of the couple. By and large most couple start enjoying sex by three months after childbirth. A woman need not consider contraceptives if she is not exposed to the risk of pregnancy either because she is amenorrhoeic (true for first six months of after childbirth) or because she is abstaining from sexual intercourse.

A recent European study revealed that after a normal birth ninety-four percent abstain from sex in first month and as postpartum duration proceeds the rate of abstinence falls. As many as twenty percent of European women abstain from sexual intercourse eight month after birth and only as twelve percent retain from sex even twelve months after a birth! By contrast, a U.S. study, conducted in 1998 revealed that two thirds of new mothers report having resuming sexual activity by fourth month. Unfortunately, in the same study was also observed that fifteen percent of lactating women with last childbirth beyond six month report being sexually active but not using any contraceptive method and thus are at risk of unintended pregnancy. Due to lack of contraceptive knowledge they are simply unaware about the possibility of unintended pregnancy.

What about India? The proportion of mothers abstaining from sexual intercourse in the first month after a birth is nearly the same as the proportion amenorrhoeic (94 percent and 96 percent, respectively), but the proportion abstaining falls far more quickly with the passage of time since birth than does the proportion who are amenorrhoeic. Only one-quarter of mothers are still abstaining from sexual intercourse four months after a birth, and by six months, 85 percent of India women have resumed sexual relations (source : NFHS – 3).