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

BackgroundPostpartum contraception start and use are important to avoid unwanted pregnancy and to optimize birth spacing. There is limited knowledge concerning the factors influencing the type and timing of contraceptive initiation and adherence after delivery. MethodsThis was a prospective register-based study. We identified 26 650 women that delivered between 1st of January 2019 and 31st of December 2019, using the Finnish Medical Birth Register. Postpartum follow-up time for each woman was one year. The primary outcome of the study was postpartum purchase of HC from a pharmacy, identified from the Prescription Centre. Additionally, we analyzed if mode of delivery, epidural analgesia, induction of labor, hypertensive complications, fear of childbirth or gestational diabetes affected HC purchase. ResultsAltogether 33% (n=8902) of the women purchased a HC method postpartum. The most purchased method was desogestrel-only pill (56%, n=4978), and other progestin-only preparations, which covered almost 90% of all methods started. Additionally, 4% (n=1141) received an intrauterine device (IUD) in primary health care. Instrumental delivery (OR 1.15, CI 1.06-1.25), cesarean section (OR 1.26, CI 1.13-1.41 for planned C-section and OR 1.25, CI 1.15-1.36 for emergency C-section), epidural analgesia (OR 1.12, CI 1.05-1.18) and induction of labor with balloon (OR 1.14, CI 1.01-1.28) were associated with a significantly higher rate of HC purchase. ConclusionsOverall, 37% of women purchased a HC method or received an IUD during the first postpartum year. Common delivery complications were associated with higher rate of postpartum HC purchase.