CHINA – Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021

by Pengcheng Tu, Denghui Hu, Shangchun Wu, Jianan Li, Xiaomei Jiang, Kaiyan Pei, Wei-Hong Zhang

BMJ Sexual and Reproductive Health, 3 May 2024  (Open access)

Abstract

Introduction Despite the widespread provision of free contraceptives and post-abortion care (PAC) services, China grapples with a high rate of unintended pregnancies and subsequent abortions. [Annual induced abortion procedures still exceed 9 million in China, with 50% of women experiencing abortion more than once.] We aimed to study the evolving characteristics of women seeking abortion and their contraceptive practices before and after abortions, to shed light on the optimisation of Chinese PAC services.

Methods This study utilised data from an abortion cohort between 2019 and 2021. We studied their demographic features, contraception and abortion histories, reasons and choices using chi-square or linear-by-linear tests. We also explored the potential impact of receiving services at PAC facilities on post-abortion contraception use and repeat abortions using logistic regression models.

Results Among the 9005 participants, 43.4% experienced repeat abortion, without a discernible trend over the 3 years. Noteworthy increases were observed in the percentages of college students (from 1.7% to 6.6%, p<0.01) and middle-aged women (from 23.2% to 26.8%, p<0.01) seeking abortions. Surgical abortion was chosen by nearly 90% of participants with a continuously increasing trend (p <0.01). Nearly half of the participants experienced unintended pregnancies due to non-use of contraception. Of the remainder, the majority preferred less or the least effective methods both before and after abortion. Women residing in moderate-gross domestic product (GDP) regions faced a higher risk of repeat abortions (OR 1.33, 95% CI 1.16 to 1.54). Despite this, high-quality PAC services may encourage the use of reliable contraceptive methods, with 86.8% of women changing from least effective or no methods to (most) effective methods post-abortion, and prevent repeat abortions (OR 0.65, 95% CI 0.56 to 0.75).

Conclusions Increased proportions of college students and middle-aged multiparous women seeking abortions were observed, together with inappropriate preferences for less effective contraception and increasing choice of surgical abortions. Future research should extend the focus to cover the entire abortion period, advocate the rational selection of contraceptive methods, and emphasise the specified PAC services tailored to different socioeconomic groups.

How this study might affect research, practice or policy These findings indicate that China’s efforts to diminish economic barriers to accessible contraception have been effective. Future studies should prioritise health education on contraception to promote correct choice and adherence, with a particular focus on often overlooked demographics such as students and women with childbirth experiences, while considering their socioeconomic status. In the light of these results, we advocate for the relevant authorities to consider incorporating comprehensive sexual health education, beyond simply the provision of free contraceptive agents, into fundamental public health services in China.