Purchase of hormonal contraceptive methods after delivery: a population-based study from Finland

BACKGROUND: Postpartum contraception start and use are important to avoid unplanned pregnancy and to optimise birth spacing. There is inconsistent knowledge concerning the background factors influencing the type and timing of contraceptive initiation and adherence after delivery. METHODS: This was a historic cohort study. We identified 26 650 women that delivered between 1 January 2019 and 31 December 2019, using the Finnish Medical Birth Register. Postpartum follow-up time for each woman was 1 year. The primary outcome of the study was postpartum purchase of hormonal contraception from a pharmacy, identified from the Prescription Centre. Additionally, we analysed if mode of delivery, epidural analgesia, induction of labour, hypertensive complications, fear of childbirth or gestational diabetes affected hormonal contraception purchase. RESULTS: Altogether, 33% (n=8902) of the women purchased a hormonal contraception method postpartum. The most purchased method was the desogestrel-only pill (56%, n=4978), and other progestogen-only preparations, which covered almost 90% of all methods started. Additionally, 4% (n=1141) received an intrauterine device (IUD) in primary healthcare. Instrumental delivery (OR 1.15, 95% CI 1.06 to 1.25), caesarean section (OR 1.26, 95% CI 1.13 to 1.41 for planned caesarean section and OR 1.25, 95% CI 1.15 to 1.36 for emergency caesarean section), epidural analgesia (OR 1.12, 95% CI 1.05 to 1.18) and induction of labour with intracervical balloon (OR 1.14, 95% CI 1.01 to 1.28) were associated with a significantly higher rate of hormonal contraception purchase. CONCLUSIONS: Overall, 37% of women purchased a hormonal contraception method or received an IUD during the first postpartum year. Common delivery complications were associated with higher rate of postpartum hormonal contraception purchase.