INTRODUCTION: Depression is a common complication that impacts perinatal outcomes. There is a paucity of literature investigating associations between an elevated Edinburgh Depression Score (EDS) 10 or greater and treatment (pharmacologic and behavioral) on postpartum visit adherence and contraception. METHODS: A retrospective cohort study of women with a singleton liveborn delivery who were screened antenatally using the EDS between 2010 and 2016 was performed. Primary outcomes were postpartum visit attendance within 12 weeks and contraception use. Secondary outcomes included contraceptive choice and effect of treatment on outcomes. Institutional Review Board approval was obtained for this study. RESULTS: 1,730 patients underwent antenatal EDS screening, and 619 (36%) had an elevated EDS. Women with an elevated EDS were more likely to be black, have higher parity, have a history of depression, or a history of drug or tobacco use. After controlling for potential confounders, women with an elevated EDS had decreased postpartum visit attendance (adjusted OR (aOR) 0.75, 95% CI 0.57–0.98, P=.03) and increased contraception use (aOR 1.37, 95% CI 1.01–1.86, P=.04), specifically with higher sterilization rates (aOR 2.13, 95% CI 1.38–3.27, P=.001). The magnitude of both postpartum visit nonattendance and sterilization rates increased with increasing EDS. Psychotherapy, but not antidepressant use, was associated with improved postpartum visit attendance, especially among those without prior diagnosis of depression (71.5% vs 92.9%, P=.03). CONCLUSION: Antenatal depressive symptomatology is associated with postpartum visit nonattendance and higher sterilization rates, with effect sizes modulated by symptom severity. Treatment with psychotherapy may improve postpartum visit attendance among women with depressive symptoms.