NHC Key Lab. of Reproduction Regulation(Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, Shanghai, China.
NHC Key Lab. of Reproduction Regulation(Shanghai Institute of Planned Parenthood Research), School of Public Health, Fudan University, Shanghai, China.
Contraception. 2021 Mar;103(3):144-150. doi: 10.1016/j.contraception.2020.12.014. Epub 2020 Dec 27.
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.
探讨中国东部、中部和西部地区以及全国产后 24 个月内避孕措施使用、非意愿妊娠和人工流产的流行情况。
我们进行了一项回顾性队列研究，在东部、中部和西部地区的 60 家医院选择了在调查前 12 至 24 个月内分娩活产的妇女。我们使用结构化问卷收集数据，并应用寿命表分析估计避孕、非意愿妊娠和流产的流行率。我们使用聚类对数秩检验比较各地区之间和各时间间隔的趋势和率差异。
共联系了 19939 名产后妇女，其中 18045 名（90.5%）同意接受采访。产后 6、12 和 24 个月时现代避孕方法的使用率分别为 62.7%（95%置信区间[CI] 58.9-66.4）、72.4%（95% CI 68.8-75.7）和 73.2%（95% CI 69.6-76.6）。避孕套占避孕起始者的 79%。产后 6、12 和 24 个月时非意愿妊娠的发生率分别为 1.4%（95% CI 1.2-1.7）、5.3%（95% CI 4.5-6.1）和 13.1%（95% CI 11.3-14.8）；人工流产的发生率分别为 1.1%（95% CI 0.8-1.3）、4.0%（95% CI 3.4-4.6）和 10.4%（95% CI 8.9-11.8）。产后 24 个月时，75%的非意愿妊娠以流产告终。与东部或中部地区相比，西部地区产后 24 个月时现代避孕方法（75.2%比 73.4%，71.1%）、非意愿妊娠（15.3%比 11.1%，12.6%）和人工流产（11.8%比 9.9%，9.4%）的使用率更高。
中国产后避孕措施的使用率相对较高，但主要是使用效果较差的方法，这可能导致产后非意愿妊娠和人工流产的风险增加。因此，中国应在产后计划生育服务中推广长效可逆避孕措施和有效可靠的短期避孕方法。
中国需要制定全国性的产后计划生育方案。服务提供者应致力于为产后妇女及其伴侣提供关于长效可逆避孕方法的咨询，并在产后期间有效、可靠地使用短期避孕方法。
