Physical disability and postpartum contraception use in Ontario, Canada: a population-based study

Objectives — To explore postpartum use of permanent contraception, intrauterine devices, oral contraception, and injectable contraception in people with and without physical disabilities.

Study design — We undertook a population-based cohort study of 15 to 49-year-olds with (n=178,400) and without physical disabilities (n=1,557,304) who had an obstetrical delivery without hysterectomy in Ontario, Canada, 2007-2021. Groups were compared using Cox proportional hazards regression on use of permanent contraception, intrauterine devices, oral contraception, and injectable contraception by 6 months postpartum, censoring on subsequent conception, hysterectomy, outmigration, or death. Models adjusted for age, parity, income quintile, rurality, immigration, and delivery year.

Results — Individuals with physical disabilities had greater hazards than those without physical disabilities of using permanent contraception (5.1% vs. 3.9%; aHR 1.30, 95% CI 1.27-1.33), intrauterine devices (11.2% vs. 10.1%; aHR 1.17, 95% CI 1.13-1.21), oral contraception (12.8% vs. 11.9%; aHR 1.08, 95% CI 1.04-1.11), and injectable contraception (4.0% vs. 3.3%; aHR 1.23, 95% CI 1.16-1.31) by 6 months postpartum. Findings were similar by 12 and 24 months postpartum.

Conclusion — Individuals with physical disabilities were more likely than those without physical disabilities to have postpartum contraception use, including permanent contraception. Future studies should explore the reasons for these patterns to inform family planning supports.