Postpartum hormonal contraceptive use in Denmark during 1997-2021

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

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.

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.

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.