Postpartum hormonal contraceptive use in Denmark during 1997-2021

OBJECTIVE: To provide an overview of postpartum hormonal contraceptive (HC) use in Denmark.

METHODS: This descriptive study used National health registries to estimate the cumulative incidence of HC initiation one year after delivery by type, calendar year, and age group among all first- and second-time mothers who delivered during 1997-2021 in Denmark. Timing of initiation is reported as the median time from delivery.

RESULTS: A total of 676 759 first-time and 552 142 second-time mothers were registered, with a cumulative incidence of HC initiation of 41.0% (95% CI, 40.9-41.1) and 40.5% (40.4-40.6), respectively. From 1997 to 2021, the cumulative incidence of first-time mothers who initially used progestogen-only pills increased from 3.8% (3.5-4.0) to 14.4% (13.9-14.8) and intrauterine levonorgestrel-releasing systems from 0.1% (0.1-0.2) to 12.6% (12.3-13.0). In contrast, combined oral contraception initiation decreased from 31.3% (30.7-31.8) to 7.8% (7.5-8.2). The median time of initiation decreased from 4.7 (Q1-Q3, 2.5-7.5) months during 1997-2001 to 2.5 (2-0-4.0) months during 2017-2021. The cumulative incidence of first-time mothers using combined HC six weeks after delivery decreased from 1.5% (1.5-1.6) during 2007-2011 to 0.5% (0.5-0.5) during 2017-2021.

CONCLUSIONS: Within the first year after childbirth, 41 % of first- and second-time mothers initiated HC in Denmark. Throughout 1997-2021, mothers started earlier after delivery and more often used progestogen-only contraception. Few started combined HC within 6 weeks after delivery. Taken together, the pattern of HC use over time reflects a change to safer contraceptive methods postpartum which minimizes thromboembolic risk.