Background: Postpartum family planning (PPFP) is essential for preventing unintended and closely spaced pregnancies, which can increase maternal and child morbidity and mortality. Despite high awareness of contraception in India, uptake of effective methods remains suboptimal, particularly in rural areas due to socio-cultural barriers and misinformation.

Aim: To evaluate the impact of structured contraceptive counselling on postpartum women’s selection and uptake in a rural tertiary care setting.

Methods: This cross-sectional interventional study was conducted at Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh, from August 2023 to April 2024. A total of 303 women aged 18–40 years in antenatal (third trimester), intrapartum, or early postpartum (<8 weeks) periods were enrolled. Pre-counselling questionnaires assessed awareness, current contraceptive practices, and myths. Structured counselling sessions (~20 minutes) followed WHO Medical Eligibility Criteria guidelines and used visual aids and educational materials. Post-counselling choices were recorded, with follow-up after one month to assess initiation and continuation.

Results: Mean participant age was 26.9 ± 4.1 years; 93.4% were literate, and 56.8% were primiparous. Before counselling, 85.15% were aware of family planning, but only 76.23% used contraception, with 21.11% relying on natural methods. Myths were reported by 50.49%, most commonly fear of permanent infertility (19.80%). After counselling, contraceptive uptake increased to 95.04%, with a marked shift toward long-acting reversible contraceptives—Copper T use rose from 11.22% to 39.58% and DMPA from 0.33% to 18.75%, while natural method uses decreased by 39.06%. At one-month follow-up, 60.76% had initiated their chosen method; discontinuation (21.52%) was mainly due to time constraints and non-availability in government supply.