Immediate versus delayed postpartum contraceptive implant on lactogenesis and breastfeeding: a systematic review and meta-analysis

To evaluate the impact of immediate postpartum contraceptive implant insertion on lactogenesis, breastfeeding outcomes, maternal satisfaction, implant continuation, and pregnancy rates within six months after delivery. This systematic review and meta-analysis followed the <i>Cochrane Handbook for Systematic Reviews of Interventions</i> and PRISMA guidelines. Randomised controlled trials comparing immediate (≤24 h after delivery) versus delayed (≥2 weeks postpartum) insertion of etonogestrel or levonorgestrel contraceptive implants were identified through PubMed, Embase, Cochrane Central, and ClinicalTrials.gov up to October 2025. Random-effects models were used to pool results, and heterogeneity was assessed by the I² statistic. The protocol was registered in PROSPERO (CRD42025117074). Eight randomised controlled trials including 881 postpartum women were analysed. Immediate insertion did not delay lactogenesis or reduce exclusive or any breastfeeding rates at six months. However, immediate insertion was associated with higher rates of exclusive breastfeeding at 3 months (RR = 1.25; 95% CI 1.02 to 1.52; <i>p</i> = 0.032) and any breastfeeding at 3 months (RR = 1.16; 95% CI −1.04 to 1.30; <i>p</i> = 0.007). Implant continuation at last follow-up was also higher with immediate insertion (RR= 1.44; 95% CI 1.19 to 1.75; <i>p</i> &lt; 0.001). No differences were found for overall satisfaction or pregnancy within 6 months postpartum. Certainty of evidence was moderate to high for primary outcomes. The results of our meta-analysis suggest that immediate postpartum contraceptive implant insertion is safe, does not interfere with lactogenesis, and maintains breastfeeding performance. Compared with delayed insertion, it increases implant continuation rates and offers a convenient, effective, and acceptable postpartum contraceptive option, particularly relevant for settings with limited postpartum follow-up access. Immediate postpartum insertion of contraceptive implants is safe, does not delay lactation, and improves early breastfeeding and continuation rates, offering an effective, convenient contraceptive option for women after delivery.