BACKGROUND:
Postnatal contraception is a key component of maternal health, preventing short interpregnancy intervals and supporting reproductive autonomy. Despite clear national guidance, provision remains inconsistent. Midwives are uniquely positioned to safeguard reproductive well-being even in the face of systemic pressures and workforce challenges.

OBJECTIVES:
To explore patterns of postnatal contraception provision and examine how midwives, alongside women and doctors, experience and implement the offer and uptake in practice.

METHODS:
This sequential mixed-methods study included Analysis of routine NHS data (n=26,081) exploring associations between obstetric and sociodemographic factors and contraception uptake. A UK-wide survey completed by women (n= 151), midwives (n=250) and doctors (n= 43). Finally, semi-structured interviews with women, midwives, and doctors across the UK. Reflexive thematic analysis was used to interpret interview data.

RESULTS:
Routine data showed higher odds of contraception provision among younger (<19 years), multiparous mothers, socioeconomically disadvantaged groups, and those undergoing caesarean births. Interviews and survey responses highlighted four key themes: 1. Midwives make the difference – continuity and antenatal counselling facilitated informed decision making; 2. Systemic inconsistency – fragmented pathways and unclear responsibilities limited; 3. Advocacy under pressure – midwives felt responsible but underprepared due to training and time; 4. Centred on women – women valued, personalised, trusted conversations with midwives.

CONCLUSIONS:
Midwives are critical in promoting equitable access to postnatal contraception but face systemic and educational barriers. Investment in training, integrated care pathways, and recognition of midwives’ advocacy role is essential.

KEY MESSAGE:
1, Midwives are pivotal to safeguarding postnatal reproductive health. 2, Antenatal counselling and continuity support informed choice. 3, System-level investment is needed to empower midwives. SRHR - Preconception/contraception (including three-minute presentation competition)