Background:To avoid unplanned, rapid repeat pregnancies, it is recommended that women use effective contraception from day 21 postpartum. This study presents a novel method for displaying postnatal contraception use over time, analysing data from highly health-literate women. Methods:This is a secondary analysis of a cross-sectional study which compared postnatal contraception use in women over 30 who had successful IVF to those who conceived without fertility treatment. This analysis uses a subset of data: 177 doctors who had conceived spontaneously. Their postnatal contraception use over time is presented using a Sankey plot. Chi-squared or Fisher's exact tests were used to compare contraception efficacy by socio-demographics and experience of contraception counselling. Qualitative data on quality of counselling were analysed using thematic analysis. Results:Contraception-efficacy was associated with timing of initiation (p<0.001); 92.3% of sexually-active participants initiating contraception before three weeks postpartum used effective or very effective methods. Overall, only 11.6% (17/146) of sexually-active participants used a very effective method as first contraception. Only contraception counselling at the place of birth was associated with initiation of effective or very effective contraception (p=0.041). Analysis of qualitative data on quality of counselling generated three themes: information provision, multi-disciplinary working, and need for self-advocacy. Conclusions:Use of effective postnatal contraception was low, despite a highly health-literate population. However, the high proportion of women choosing effective contraception before three weeks postpartum indicates acceptability where available. The Sankey plot is an effective visual that could be used to monitor and evaluate postnatal contraception services and interventions.