• Contraception is not needed in the first 20 days after delivery, but is required from day 21 if the woman is not fully breastfeeding and does not want to become pregnant.
• Women who are breastfeeding and are less than 6 weeks postpartum
• Methods that can be used without restriction: lactational amenorrhoea method (if fully or almost fully breastfeeding and amenorrhoeic), progestogen-only pill, progestogen-only implants, copper intrauterine devices (IUDs) and the levonorgestrel-releasing intrauterine system (IUS) (use within 48 hours or from 4 weeks after delivery), and barrier methods.
• The National Institute for Health and Clinical Excellence recommends that the IUD and IUS be inserted at least 4 weeks after delivery.
• Methods that can generally be used (advantages generally outweigh the risks): progestogen-only injectables.
• Methods that are not usually recommended (risks usually outweigh the advantages): copper IUDs (from 48 hours up to 4 weeks after delivery) and the levonorgestrel-releasing IUS (from 48 hours up to 4 weeks after delivery).
• Methods that should not be used (because of unacceptable health risk): combined oral contraceptives (COCs), combined contraceptive patch, and combined contraceptive vaginal ring.
• Fertility awareness–based methods: a previous user can start from day 21, but a new user should delay learning to use the method until her periods start.
• Sterilization is usually delayed until the woman is 6 weeks or more postpartum.
• Women who are fully or almost fully breastfeeding and are between 6 weeks and 6 months postpartum
• Methods that can be used without restriction: lactational amenorrhoea method (if amenorrhoeic), progestogen-only pill, progestogen-only injectables and implants, copper IUDs, levonorgestrel-releasing IUS, barrier methods, and sterilization.
• Fertility awareness–based methods: a previous user can start, but a new user should delay learning to use the method until her periods start.
• Methods that are not usually recommended: COCs, combined contraceptive patch, and combined contraceptive vaginal ring.
• Women who are not fully or almost fully breastfeeding and are between 6 weeks and 6 months postpartum
• Methods that can be used without restriction: progestogen-only pill, progestogen-only injectables and implants, copper IUDs, the levonorgestrel-releasing IUS, barrier methods, and sterilization.
• Methods that can generally be used (advantages generally outweigh the risks): COCs, combined contraceptive patch, and combined contraceptive vaginal ring.
• Fertility awareness–based methods: a previous user can start, but a new user should delay learning to use the method until her periods start.
• There are no methods that should not be used (because of unacceptable health risk).
• For women who are breastfeeding and are 6 months or more postpartum
• Methods that can be used without restriction: COCs, combined contraceptive patch, combined contraceptive vaginal ring, progestogen-only pill, progestogen-only injectables and implants, copper IUDs, the levonorgestrel-releasing IUS, barrier methods, and sterilization.
• Fertility awareness–based methods: a previous user can start, but a new user should delay learning to use the method until her periods start.
• The lactational amenorrhoea method does not provide adequate protection from unplanned pregnancy after 6 months postpartum.
• Fertility awareness–based methods should be delayed. Fertility signs and hormonal changes are unlikely to be detectable before 4 weeks postpartum.
• Sterilization is usually delayed until the woman is 6 weeks or more postpartum.

• Full and partial breastfeeding
• The term postpartum includes any births, including stillbirths from 24 weeks' gestation.
• Full breastfeeding is defined as exclusive when no other liquids or solids are given, and as almost exclusive when vitamins, water, or juice is given infrequently in addition to breastfeeds.
• Partial breastfeeding is defined as:
• High when the majority of feeds are breastfeeds.
• Medium when about half of feeds are breastfeeds.
• Low when the majority of feeds are not breastfeeds.
• The term almost fully breastfeeding includes almost exclusive breastfeeding and high partial breastfeeding.

[FFPRHC, 2006a]

• These recommendations are based on guidelines published by the Faculty of Sexual and Reproductive Health Care (FSRHC), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FSRH, 2009b].
• Combined hormonal contraceptives may reduce the volume of breast milk if used before 6 weeks postpartum.
• Combined hormonal contraceptives do not appear to affect infant growth if used after 6 weeks postpartum, although the evidence of their effect on the quality and quantity of breast milk is poor.
• Combined hormonal contraceptives can be used safely, but are unlikely to be required, in women who are fully or almost fully breastfeeding, amenorrhoeic, and less than 6 months postpartum.
• The National Institute for Health and Clinical Excellence recommends that the IUD and IUS be inserted at least 4 weeks after delivery [National Collaborating Centre for Women's and Children's Health, 2005].