Repeat Induced Abortion among Chinese Women Seeking Abortion: Two Cross Sectional Studies

Background: In China, there were about 9.76 million induced abortions in 2019, 50% of which were repeat abortions. Understanding the tendency of repeat induced abortion and identifying its related factors is needed to develop prevention strategies. Methods: Two hospital-based cross-sectional surveys were conducted from 2005–2007 and 2013–2016 in 24 and 90 hospitals, respectively. The survey included women who sought an induced abortion within 12 weeks of pregnancy. The proportion of repeat induced abortions by adjusting the covariates through propensity score matching was compared between the two surveys, and the zero-inflated negative binomial regression model was established to identify independent factors of repeat induced abortion. Results: Adjusting the age, occupation, education, marital status and number of children, the proportion of repeat induced abortions in the second survey was found to be low (60.28% vs. 11.11%), however the unadjusted proportion was high in the second survey (44.97% vs. 51.54%). The risk of repeat induced abortion was higher among married women and women with children [ORadj and 95% CI: 0.31 (0.20, 0.49) and 0.08 (0.05, 0.13)]; the risk among service industry staff was higher when compared with unemployed women [ORadj and 95% CI: 0.19 (0.07, 0.54)]; women with a lower education level were at a higher risk of a repeat induced abortion (ORadj \u3c 1). Compared with women under the age of 20, women in other higher age groups had a higher frequency of repeat induced abortions (IRadj: 1.78, 2.55, 3.27, 4.01, and 3.93, separately); the frequency of women with lower education levels was higher than those with a university or higher education level (IRadj \u3e 1); the repeat induced abortion frequency of married women was 0.93 (0.90, 0.98) when compared to the frequency of unmarried women, while the frequency of women with children was 1.17 (1.10, 1.25) of childless women; the induced abortion frequency of working women was about 60–95% with that of unemployed women. Conclusions: The repeat induced abortion proportion was lower than 10 years ago. Induced abortion seekers who were married, aged 20 to 30 years and with a lower education level were more likely to repeat induced abortions

Repeat abortion in Chinese adolescents: a cross-sectional study in 30 provinces

Background: Premarital sex has become more acceptable in China nowadays. The Chinese Family Planning (FP) programme mainly focuses on married couples, and young unmarried women have little access to information or advice about contraception. Abortion is commonly used to end unintended pregnancies in China. This study aimed to determine risk factors related to repeat abortions in Chinese adolescents. Methods: This cross-sectional study was one component of an EU-funded project and was conducted between March 20, and Oct 5, 2013 in China. We collected data using a questionnaire filled by abortion service providers for all women seeking abortions within 12 weeks of pregnancy during a period of 2 months in selected hospitals. A total of 297 hospitals were randomly selected across 30 provinces using a stratified cluster sampling design according to the level and type of hospital. In this study, only the adolescents (younger than the minimum legal married age of 20 years for women, unintendedly pregnant) were included for analysis. All participants signed a written informed consent of which they received a copy. Ethics approvals were obtained from both ethics committees of the National Research Institution for Family Planning (NRIFP), China, and of the Ghent University, Belgium. Findings: Of the 2370 adolescents (median age 19 years, range 13–19), 927 (39%) were undergoing repeat abortions, 206 (9%) for a third time or more. The primary reason for their unintended pregnancies was non-use of contraception (1609, 68%), followed by ineffective contraception (761, 32%). After adjusting for potential confounding factors, the adolescents who had an increased risk of repeat abortions were those who had children (OR 2·63, 95% CI 1·82–3·78), those who resided in a middle-developed region (1·79, 1·30–2·48), those who resided in a relatively poor region (2·37, 1·77–3·17), and those who had used contraception during the 6 months preceding the survey (1·34, 1·08–1·65 for condom use). Adolescents who were students had a lower risk of repeat abortions than did those who were not students (0·69, 0·54–0·88). Interpretation: Repeat abortions among adolescents are highly prevalent in China. Adolescents should be offered equal access to FP in China to that of married women to reduce unintended pregnancies and repeat abortions. Correct and consistent contraception practice among adolescents should be promoted. Funding: The European Commission under the Seventh Framework Programme (FP7): INtegrating Post-Abortion Family Planning Services into China\u27s existing abortion services in hospital setting (INPAC), 282490

Repeat induced abortion among Chinese women seeking abortion : two cross sectional studies

Background: In China, there were about 9.76 million induced abortions in 2019, 50% of which were repeat abortions. Understanding the tendency of repeat induced abortion and identifying its related factors is needed to develop prevention strategies. Methods: Two hospital-based cross-sectional surveys were conducted from 2005–2007 and 2013–2016 in 24 and 90 hospitals, respectively. The survey included women who sought an induced abortion within 12 weeks of pregnancy. The proportion of repeat induced abortions by adjusting the covariates through propensity score matching was compared between the two surveys, and the zero-inflated negative binomial regression model was established to identify independent factors of repeat induced abortion. Results: Adjusting the age, occupation, education, marital status and number of children, the proportion of repeat induced abortions in the second survey was found to be low (60.28% vs. 11.11%), however the unadjusted proportion was high in the second survey (44.97% vs. 51.54%). The risk of repeat induced abortion was higher among married women and women with children [ORadj and 95% CI: 0.31 (0.20, 0.49) and 0.08 (0.05, 0.13)]; the risk among service industry staff was higher when compared with unemployed women [ORadj and 95% CI: 0.19 (0.07, 0.54)]; women with a lower education level were at a higher risk of a repeat induced abortion (ORadj 1); the repeat induced abortion frequency of married women was 0.93 (0.90, 0.98) when compared to the frequency of unmarried women, while the frequency of women with children was 1.17 (1.10, 1.25) of childless women; the induced abortion frequency of working women was about 60–95% with that of unemployed women. Conclusions: The repeat induced abortion proportion was lower than 10 years ago. Induced abortion seekers who were married, aged 20 to 30 years and with a lower education level were more likely to repeat induced abortions

Is Repeat Abortion a Public Health Problem among Chinese Adolescents? A Cross-Sectional Survey in 30 Provinces

The Chinese Family Planning (FP) programme mainly focuses on married couples, and young unmarried women have limited access. This cross-sectional study aims to identify risk factors related to repeat abortions in Chinese adolescents receiving abortions. Data were collected using a questionnaire for all women seeking abortions within 12 weeks of pregnancy during a period of 2 months in 297 participating hospitals randomly selected across 30 provinces of China in 2013. Only the adolescents (younger than the minimum legal married age of 20 years) were included in this study. Of the 2370 adolescents who were receiving abortions, 927 (39%) were undergoing repeat abortions. The primary reason for the current unintended pregnancies was non-use of contraception (68%). Adolescents receiving abortions who had an increased risk of repeat abortions were those who had children (OR 2.57, 95% CI 1.80–3.67), those who resided in a middle-developed region (OR 1.81, 95% CI 1.30–2.50), those who resided in a relatively poor region (OR 2.40, 95% CI 1.78–3.23), and those who had used contraception during the 6 months preceding the survey (OR 1.38, 95% CI 1.12–1.71 for condom use). The occupation as a student was a protective factor for adolescents (OR 0.64, 95% CI 0.50–0.83). Adolescents should be offered equal access to FP to that of married women in China to reduce unintended pregnancies and repeat abortions. Correct and consistent contraception practice should be promoted

A qualitative exploration of perceptions and experiences of contraceptive use, abortion and post-abortion family planning services (PAFP) in three provinces in China

Background: The INPAC project aims to evaluate the effectiveness of integrated post-abortion family planning (PAFP) services into existing hospital based abortion services in China. A qualitative study was conducted in three provinces to contribute to developing effective PAFP services through understanding influences on contraceptive use, experiences of abortion and existing PAFP, and their effect on future contraceptive practices from the perspective of users, in the context of social and institutional change. Methods: Twenty-nine in-depth interviews (IDIs) were undertaken with women who had experienced abortion between 1 and 6 months prior to interview, recruited from three urban and two rural facilities in each province. Thirteen IDIs were also conducted with male partners. Six focus group discussions (FGDs) were carried out with community members from different social groups, including unmarried and married women and men, urban residents and rural-to-urban migrants. Results: Social networks and norms are important in shaping attitudes and behaviour towards abortion and contraception. Widespread concerns were expressed about side-effects, reliability and effects on future fertility of some modern contraceptives. The combination of limited information and choices and a lack of person-centred counselling in PAFP with anxieties about side effects underlies the widespread use of unreliable methods. Gendered power relations significantly influence contraceptive (non) use, with several examples illustrating women's relative lack of power to decide on a method, particularly in the case of condoms. Although the availability of contraceptive information from respected providers can offer impetus for individual behaviour change, social distance from providers reduces opportunities for clients to discuss their difficulties regarding contraceptive use; particularly, but not exclusively for young, unmarried clients. Conclusions: Increased access to non-commercial, reliable information on contraceptive methods is needed. PAFP services must go beyond simple information provision to ensure that providers take a more personcentred approach, which considers the most appropriate method for individual clients and probes for the underlying influences on contraceptive (non) use. More sensitive reflection on gender norms and relationships is required during counselling and, where women choose this, efforts should be made to include their male partners. Specific attention to provider positionality and skills for counselling young, unmarried clients is needed

Induced abortion in 30 Chinese provinces in 2013: a cross-sectional survey

Background: Galloping economic growth and reform in China in the past 30 years has led to dramatic social changes. Attitudes towards sex and sexual behaviour have changed, and premarital sex has become more acceptable. The methods of contraception have changed, and the use of highly effective or long-acting contraceptive methods tends to be decreasing, especially in urban areas. Abortion is commonly used to end unintended pregnancy. The aim of this study was to survey the current situation of induced abortions in selected hospitals in 30 provinces in China. Methods: This cross-sectional study was conducted in 295 randomly selected hospitals in 30 Chinese provinces between April and August, 2013. We collected data using a questionnaire filled by the abortion service providers for all women seeking abortion within 12 weeks of pregnancy during a period of two months. The information included self-reported demographic and economic characteristics, history of induced abortion, and use of contraception. The characteristics of women were summarised with counts (percentages) for categorical variables; mean (SD) and range for age of women. All participants signed a written informed consent of which they received a copy. Ethics approvals were obtained from both ethics committees of the National Research Institution for Family Planning (NRIFP), China, and of the Ghent University, Belgium. Findings: 79 174 women participated in the study (mean age 28∙9 years (SD 1∙7; range 13–58), of whom 27 134 (35%) were undergoing a first induced abortion, 28 637 (37%) a second abortion, and 22 682 (29%) a third or subsequent abortion. About a third of participants (31%) were not married and more than half (61%) were not local residents. The primary reasons for the unintended pregnancy were contraception failure (50%) and non-use of contraception (44%). Interpretation: This is the first nationwide large-scale study in 30 provinces to show that repeated induced abortion is high in China. A family planning programme for young and unmarried people is urgently needed to improve their access to information, advice, and services about contraception and to reduce unintended pregnancies and repeated induced abortion. Funding: The European Commission (EC) under the Seventh Framework Programme (FP7), project number 282490

Opportunities, challenges and systems requirements for developing post-abortion family planning services: Perceptions of service stakeholders in China

Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers’ perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces—Zhejiang, Hubei and Yunnan—were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources

Challenges in providing post-abortion family planning in hospital settings in China: lessons learned from a nationwide randomized clinical trial.

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Characteristics of service providers and their Knowledge, Attitudes and Practice (KAP) on post-abortion contraception services: A national cross-sectional studies in China

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Characteristics of service providers and their Knowledge, Attitudes and Practice (KAP) on post-abortion contraception services: two cross-sectional studies in China.

info:eu-repo/semantics/nonPublishe