Contraception After Childbirth: Your Options, With or Without Breastfeeding

Baby is three weeks old, the house is still full of visitors, and the question seems far away. Yet contraception after childbirth needs preparing early: ovulation can return from day 21, even before the first periods, and breastfeeding protects only under very precise conditions.

In Morocco, many couples wait for the end of the nfissa, the forty days after the birth, to resume sex. Better to have settled the question by then, because fertility does not always wait for the forty days to end.

How soon can you get pregnant again after a birth?

From day 21 after the birth. France's national health authority (HAS) points out that there is no ovulation before day 21 after the birth: contraception is therefore not needed before that date, but it becomes needed afterwards. The UK's NHS puts it differently: pregnancy is possible from three weeks after the birth, even if you breastfeed and even if your periods have not returned.

The trap is that the first ovulation comes before the first periods. Waiting for the return of periods to get organised is therefore taking a risk. The WHO family planning handbook advises starting a method as soon as it is possible, without waiting for bleeding.

For resuming sex, no date is imposed: each couple goes at its own pace, as our article on sex after childbirth explains.

Does breastfeeding protect against pregnancy?

Yes, but only if every condition of LAM is met. LAM, the lactational amenorrhoea method (MAMA in French), rests on a simple mechanism: frequent feeds, day and night, block ovulation. According to the HAS, it can serve as contraception until baby is 6 months old, provided that:

• baby is exclusively breastfed, with no other milk, no water and no food;
• baby feeds day and night, 6 to 10 times per 24 hours;
• no more than 4 hours pass between feeds by day, nor more than 6 hours at night;
• your periods have not returned, not even a little spotting.

Under these conditions, the risk of pregnancy stays below 2% at six months. But it takes just one condition to fail for the protection to disappear: baby sleeps long stretches at night, a supplement is introduced, you go back to work, solid foods begin.

The NHS adds two useful points. Expressing milk might make the method less reliable, without knowing to what extent. And the dummy is part of what "is not breast milk". If you express your milk regularly, plan another method.

You are breastfeeding: which methods, and from when?

During breastfeeding, you choose an oestrogen-free method. Here are the markers from the WHO, the HAS and the NHS:

The "classic" pill, called combined because it pairs an oestrogen with a progestogen, is not suited to breastfeeding. The WHO rules it out before 6 weeks and advises against it until baby is 6 months: it can reduce milk production, and the risk of thrombosis (a clot in a vein) remains high during the six weeks after delivery. The same rules apply to the vaginal ring and the patch.

Even with a progestogen method, keep an eye on your milk supply: a Canadian document notes that a hormonal method can sometimes lower it. If so, talk to your doctor or midwife.

Then there is sterilisation, meaning tubal ligation. The HAS reminds us that it must be presented as irreversible and is performed within 7 days of delivery or from 6 weeks. It is a decision to think over for a long time with your gynaecologist.

You are not breastfeeding: what changes

All the methods in the table remain possible, with the same timing. The difference concerns the combined pill, the ring and the patch. The HAS allows them from 42 days, so 6 weeks, because the risk of thrombosis stays high until then. The WHO and the NHS allow starting from 21 days if no risk factor is present, such as:

• a caesarean, a haemorrhage after delivery or a transfusion;
• pre-eclampsia during pregnancy;
• a history of phlebitis or embolism, or a clotting disorder;
• obesity (BMI above 30), smoking or prolonged immobilisation.

Your doctor or midwife does this sorting. So do not restart the pre-pregnancy pack by yourself, nor a sister's or friend's: the right pill depends on your situation now.

Why does advice change from one country to another?

From one country to another, the timing varies:

• in the United Kingdom, the NHS allows the implant, the injection and the progestogen-only pill from birth, even while breastfeeding, and some maternity units offer them before discharge;
• in France, the HAS starts progestogens at day 21, since no ovulation occurs before then;
• in Canada, Nova Scotia Health is more cautious: progestogens from 6 weeks, once breastfeeding is well established, and an IUD after 6 weeks;
• the WHO judges that, in a breastfeeding woman, the benefits of the progestogen-only pill and the implant outweigh the risks before 6 weeks, and sets no restriction afterwards.

These gaps reflect two priorities: protecting the start of breastfeeding, and avoiding a closely spaced pregnancy in women who will not all come back for a visit. No approach is wrong. The decision is made with your health professional, according to your breastfeeding, your health and your plans. If latching is still difficult, our guide to getting breastfeeding off to a good start supports you.

How long to wait before the next baby?

Here again, the markers vary. The WHO family planning handbook considers that waiting at least 2 years before conceiving again is best for the child and good for the mother. The NHS speaks of at least 12 months, and the Canadian document of 18 months if possible. A pregnancy too close raises certain risks, such as low birth weight.

This delay also gives your body time to recover: our article on the postpartum period details these first weeks.

Where to get advice in Morocco

The best time to talk about it is before leaving the maternity ward, then at the postnatal consultation, which the HAS places between 6 and 8 weeks. A gynaecologist, midwife, health centre doctor or pharmacist can guide you. Always say whether you breastfeed: it changes the method offered.

In Morocco, according to WHO figures reported by TelQuel in 2023, 71% of married women use contraception and 61% a modern method, most often the pill. The three-monthly injection is available, and a self-injected version was trialled in seven cities from 2021, as part of the national family planning strategy. In 2023, the Health Minister also announced the arrival of the implant. Ask your doctor or health centre what is offered near you.