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The association between postpartum depressive symptoms and contraception
Chloe N Matovina1, Allie Sakowicz2, Emma C Allen3
1Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
American Journal of Obstetrics and Gynecology
|March 29, 2024
Summary
Severe postpartum depression symptoms significantly decrease the likelihood of birthing people choosing any contraception. This highlights a critical need for integrated mental and reproductive healthcare to support informed family planning decisions.
Area of Science:
- Perinatal mental health
- Reproductive health
- Public health
Background:
- Postpartum depression (PPD) affects 10-20% of birthing individuals, impacting healthcare utilization.
- Little is known about the link between PPD symptoms and contraceptive choices.
- Untreated depression and short interpregnancy intervals pose significant perinatal risks.
Purpose of the Study:
- To investigate the association between postpartum depressive symptoms and decisions regarding contraception use.
- To determine if the severity of depressive symptoms influences contraceptive choices.
Main Methods:
- Retrospective cohort study of 1871 birthing individuals (2017-2022) in a collaborative care mental health program.
- Postpartum depressive symptoms assessed using Patient Health Questionnaire-9 (PHQ-9), stratified by severity.
- Contraceptive method choice documented in electronic health records, dichotomized as 'none' if declined at delivery and postpartum visit.
Main Results:
- 8.5% of participants had moderately severe or worse PPD (PHQ-9 >14); 2.3% had severe PPD (PHQ-9 >19).
- Higher PHQ-9 scores correlated with medical comorbidities, higher BMI, and non-White/Hispanic ethnicity.
- Increasing depressive symptom severity was significantly associated with declining any contraceptive method (aOR 2.92 for severe symptoms).
Conclusions:
- Severe PPD symptoms are linked to a refusal of all postpartum contraception.
- This association is critical given current threats to abortion access, potentially increasing unintended pregnancies.
- Integrated perinatal mental health and reproductive services are crucial for supporting contraceptive decision-making.
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