Background: The postpartum period offers a critical opportunity to address unmet family planning needs, yet many women in rural India lack access to comprehensive contraceptive counselling. Structured counselling, focusing on informed choice and client-centred discussion, may improve method uptake and reduce reliance on less effective options.

Objectives: To evaluate the impact of structured counselling on postpartum contraceptive awareness, method preference, and adoption among rural women.

Methods: This cross-sectional, interventional study was conducted from August 2023 to April 2024 at Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh. A total of 303 women aged 18–40 years, recruited during antenatal, intrapartum, or postpartum visits, were enrolled. Eligible participants completed a pre-counselling questionnaire assessing baseline awareness and practices, followed by a 20-minute structured counselling session based on WHO Medical Eligibility Criteria. Post-counselling, contraceptive preferences were recorded, and follow-up at one month assessed initiation and continuation. Data were analysed using SPSS version 26.0, with p<0.05 considered significant.

Results: The mean age of participants was 26.9 ± 4.1 years; 56.77% had one live child. Pre-counselling, 85.15% were aware of family planning, but modern method use was limited: barrier methods (31.68%) and copper T (11.22%) were most common, while DMPA use was 0.33%. Post-counselling, undecided women decreased from 23.76% to 4.96%, natural method use declined by 39.06%, and LARC adoption increased substantially—copper T from 34 to 114 women, and DMPA from 1 to 54 women. At one-month follow-up, 60.76% had initiated their chosen method, 17.70% had not started, and 21.52% had discontinued, mainly due to time constraints, method unavailability, and partner/family refusal.