To explore the prevalence of contraceptive use, unintended pregnancy, and induced
abortions within 24 months postpartum in eastern, central, and western regions of
China and in China overall.
We conducted a retrospective cohort study and selected women who delivered a live
birth between 12 and 24 months before the survey at 60 hospitals in eastern, central,
and western regions of China. We used structured questionnaires for data collection
and applied life-table analyses to estimate the prevalence of contraception, unintended
pregnancy, and abortions. We used clustered log-rank tests to compare trends and rate
differences at each time interval between/among regions.
A total of 19,939 postpartum women were contacted, and 18,045 (90.5%) of them agreed
to be interviewed. The 6-, 12-, and 24-month rates for modern contraceptive methods
were 62.7% (95% confidence interval [CI] 58.9–66.4), 72.4% (95% CI 68.8–75.7), and
73.2% (95% CI 69.6–76.6), respectively. Condoms accounted for 79% of contraceptive
initiators. The 6-, 12-, and 24-month rates were 1.4% (95% CI 1.2–1.7), 5.3% (95%
CI 4.5-–6.1), and 13.1% (95% CI 11.3–14.8) for unintended pregnancy; and 1.1% (95%
CI 0.8–1.3), 4.0% (95% CI 3.4–4.6), and 10.4% (95% CI 8.9–11.8) for induced abortion,
respectively. By 24 months postpartum, 3-quarters of unintended pregnancies ended
in abortion. The 24-month rates of modern contraceptive methods (75.2% vs73.4%, 71.1%),
unintended pregnancy (15.3% vs 11.1%, 12.6%), and induced abortion (11.8% vs 9.9%,
9.4%) were higher in the western region relative to the eastern or central regions.
Postpartum contraception use was relatively high in China but dominated by less-effective
methods, and these may contribute to higher risks of unintended pregnancy and induced
abortion during the postpartum period. Use of long-acting reversible contraceptives
and effective and reliable short-acting methods should thus be fostered in postpartum
family planning services in China.
A national postpartum family planning program is needed in China. Service providers
should work on counselling postpartum women and their partners with respect to long-acting
reversible contraceptive methods, and to effectively and reliably use short-acting
methods during the postpartum period.