We sought to determine the prevalence of postpartum contraceptive use amongst women with postpartum depressive symptoms (PDS) and to evaluate the association between PDS and contraceptive method.METHODS:
We evaluated data from 16,418 women participating in the 2009–2011 Pregnancy Risk Assessment Monitoring System, which included three questions on depression, hopelessness, and feeling physically slowed. PDS was defined as an additive score of greater than or equal to 10. Contraceptive use was categorized as permanent, long-acting reversible contraception (LARC), user-dependent hormonal, and user-dependent non-hormonal. Chi-square tests compared any contraceptive use and contraceptive method by PDS status. Three logistic regression models generated adjusted prevalence ratios (aPR) for associations between PDS and any contraception among all women; permanent contraception among contraceptive users; and LARC among women using reversible contraception.RESULTS:
Of the 11.8% of women with PDS, 39.8% reported using non-hormonal or no contraception, compared to 43.8% of women without PDS (P=.02). There was no association between PDS and use of any postpartum contraception (aPR=1.01, 95% CI 0.98–1.03) or permanent contraception (aPR=1.05, 95% CI 0.88–1.27). Among the 76.4% of women using reversible contraception, women with PDS were slightly more likely (aPR=1.16 95% CI 1.00–1.34) to use LARC compared to women without PDS.CONCLUSION:
Despite no association with postpartum contraceptive use overall, over a third of women with PDS used non-hormonal or no contraception postpartum. These findings underscore the importance of screening postpartum women for depressive symptoms and counseling them about effective contraception and the benefits of LARC.