Contraception, unintended pregnancy, and induced abortion within 24 months of delivery in China: a retrospective cohort study



      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.

      Study Design

      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Contraception
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • DaVanzo J
        • Hale L
        • Razzaque A
        • Rahman M.
        Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab.
        Bangladesh. BJOG. 2007; 114: 1079-1087
        • Conde-Agudelo A
        • Rosas-Bermudez A
        • Castano F
        • Norton MH.
        Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms.
        Stud Fam Plann. 2012; 43: 93-114
        • World Health Organization, USAID, Mathernal and Child Health Integrated Program.
        Programming Strategies for Postpartum Family Planning.
        Geneva: World Health Organization. 2013;
        • White K
        • Teal SB
        • Potter JE.
        Contraception after delivery and short interpregnancy intervals among women in the United States.
        Obstet Gynecol. 2015; 125: 1471-1477
        • Dev R
        • Kohler P
        • Feder M
        • Unger JA
        • Woods NF
        • Drake AL.
        A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries.
        Reprod Health. 2019; 16: 154
        • Huang YM
        • Merkatz R
        • Kang JZ
        • Roberts K
        • Hu XY
        • Di Donato F
        • et al.
        Postpartum unintended pregnancy and contraception practice among rural-to-urban migrant women in Shanghai.
        Contraception. 2012; 86: 731-738
        • Huang YM
        • Kang J
        • Hu X
        • Chen R
        • Cheng L.
        Study on unintended pregnancy and risk factors among postnatal women in Shanghai.
        Reproduction and Contraception. 2008; 28: 286-290
        • Kang C
        • Li P
        • Liu X
        • Ding Y
        • Wang X
        • Zhou H.
        Use of contraceptives and uptake of long-acting reversible contraception among postpartum women in rural China.
        BMJ sexual & reproductive health. 2018;
        • Singh S
        • Reme L
        • Sedg G
        • Kwok L
        • Onda T.
        Abortion worldwide 2017:uneven progress and uneuqal access.
        Guttmacher Institute, New York2018
        • Ahrens KA
        • Thoma ME
        • Copen CE
        • Frederiksen BN
        • Decker EJ
        • Moskosky S.
        Unintended pregnancy and interpregnancy interval by maternal age, National Survey of Family Growth.
        Contraception. 2018; 98: 52-55
        • Moore Z
        • Pfitzer A
        • Gubin R
        • Charurat E
        • Elliott L
        • Croft T.
        Missed opportunities for family planning: an analysis of pregnancy risk and contraceptive method use among postpartum women in 21 low- and middle-income countries.
        Contraception. 2015; 92: 31-39
        • Xiao H
        • Qin C
        • Yan H
        • Li S
        • Xu D.
        Prevalence and related reasons of unintended pregnancy in the first year of delivery among married women in Enshi.
        Chinese Journal of Disease Control & Prevention. 2014; 18: 876-879
        • National Health Commission
        China's Health Statistics Yearbook 2018.
        Beijing: Peking union medical college press, 2019
        • Donner A
        • Birkett N
        • Buck C.
        Randomization by cluster. Sample size requirements and analysis.
        Am. J. Epidemiol. 1981; 114: 906-914
        • Hayes RJ
        • Bennett S.
        Simple sample size calculation for cluster-randomized trials.
        Int J Epidemiol. 1999; 28: 319-326
        • Whiteman M
        • Curtis K
        • Hillis S
        • Zapata L
        • D'Angelo D
        • Farr SL
        • et al.
        Contraceptive Use Among Postpartum Women — 12 States and. 58. MMWR weekly, New York City2009: 821-826 (2004–2006)
        • Wilopo SA
        • Setyawan A
        • Pinandari AW
        • Prihyugiarto T
        • Juliaan F
        • Magnani RJ.
        Levels, trends and correlates of unmet need for family planning among postpartum women in Indonesia.
        BMC Womens Health. 2017; 17 (2007-2015): 120
        • Mehata S
        • Paudel YR
        • Ranju Mehta
        • Dariang M
        • Poudel P
        • Barnett4 S
        Unmet Need for Family Planning in Nepal during the First Two Years Postpartum.
        BioMed Research International [Internet], 2014: 1-9 (2014)
        • World Health Organization Department of Reproductive Health and Research (WHO/RHR)
        Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Knowledge for Health Project. Family Planning: A Global Handbook for Providers (2018 update).
        Baltimore and Geneva: CCP and WHO, 2018
        • Ruo L
        • Zhang J
        • Luo J.
        An investigation of the unintended pregnancy and induced abortion in Pengshan District of Meishai City.
        Journal of Hainan Medicine. 2018; 29: 1305-1308
        • National Bureau of Statistics
        In 2017, the State economic operation was stable, positive and better than expected.
        National Bureau of Statistics, 2018 ([cited 2020 June 6]. Available from)
        • Wu S
        • Wang K
        • Dong J
        INPAC-WP3: Main results of a cross-section study In.
        in: Zhang W.H Che Y Intervention study of postabortion family planning service in China: Design and implementation of the EU-FP7 INPAC project. China Population Publishing House, Beijing2017