Contraceptive practices of women requesting termination of pregnancy: a study from China

Risk of unsafe abortion associated with long-term contraception behaviour: a case control study from Sri Lanka

Background

When faced with an unintended pregnancy, some women choose to undergo an unsafe abortion, while others do not. This choice may depend on long-term contraception that shapes the fertility goals of women, along with many other risk factors. We assessed the risk for unsafe abortion associated with contraceptive practices based on women’s long-term behaviour, and its likely modification by the use of different types of contraceptives among women in Sri Lanka.

Methods

An unmatched case-control study was conducted in nine hospitals among 171 women admitted for care following an unsafe abortion (Cases) and 600 women admitted to same hospitals for delivery of an unintended term pregnancy (Controls). Interviewer-administered-questionnaires assessed their socio-economic, reproductive and fertility (decisions on family size, family completion) characteristics, contraceptive method last used (traditional, modern), reasons for discontinuation/never-use, and contraceptive practices assessed at different time points.

Using several regression models, the risk of abortion was assessed for ‘non-use’ of contraception against ‘ineffective use’ at conception; for non-use further categorised as ‘never-use’, ‘early-discontinuation’ (discontinued before last birth interval) and ‘late-discontinuation’ (discontinued during last birth interval); and for any interaction between the contraceptive practice and contraceptive method last used among the ever-users of contraception.

Results

At conception, ‘non-use’ of contraception imparted a two-fold risk for abortion against ineffective use (adjusted-OR = 2.0; 95% CI: 1.2–3.2). The abortion risk on ‘non-use’ varied further according to ‘early’ (adjusted-OR = 1.7; 95% CI: 1.1–3.1) and ‘late’ (adjusted-OR = 2.3; 95% CI: 1.5–3.6) discontinuation of contraception, but not with ‘never-use’ (crude-OR = 1.1; 95% CI: 0.6–2.3).

Among the ever-users, the risk of abortion varied within each contraceptive practice by their last used contraceptive method and reasons for discontinuation. A significant interaction between modern contraceptives and early discontinuation (adjusted-OR = 1.4; 95% CI = 1.1–3.1) demonstrated a seven-fold abortion risk for early discontinuation of modern methods against its ineffective use. In particular, hormonal methods seemed to be responsible for this risk (51.1% cases versus 42.5% controls).

Conclusions

Long-term contraceptive practices showed varying risk for abortion, and was further modified by early discontinuation of modern contraceptives. This knowledge should be applied during postnatal visits by public-health staff.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1376-7) contains supplementary material, which is available to authorized users.

Contraception and Unintended Pregnancy among Unmarried Female University Students: A Cross-sectional Study from China

This study aims to understand the level of contraceptive knowledge and attitudes towards contraception, and then to explore the association between the contraceptive behavior and unintended pregnancy in unmarried female university students in China. A cross-sectional study was conducted of university students in 49 universities across 7 cities in China from September 2007 to January 2008. We distributed 74,800 questionnaires, of which 69,842 were returned. In this paper, the data from 35,383 unmarried female university students were analyzed. The prevalence of sexual intercourse in unmarried female university students was 10.2%. The prevalence of unintended pregnancy in those sexually active female university students, was 31.8%. Among students with pregnancy, 53.5% experienced two or more pregnancies. 28.3% of the students with sexual intercourse reported that they always adopted contraceptive methods, and of those 82.9% chose to use male condoms. The majority (83.9%) of students with unintended pregnancy chose to terminate the latest pregnancy by surgical abortion or medical abortion. The contraceptive knowledge level of students who experienced unintended pregnancy was lower than those who did not. In China, about one third of unmarried female students with sexual intercourse experience unintended pregnancy. A variety of contraceptive methods are adopted, but the frequency of contraceptive use is low. Most of unmarried female students who experienced unintended pregnancy would choose to terminate the pregnancy with surgical or medical abortion. University students, especially the ones who have experienced unintended pregnancy, lack contraceptive and reproductive health knowledge.

Unintended pregnancy and its correlates among female attendees of sexually transmitted disease clinics in Eastern China

This study is to determine the prevalence of unintended pregnancy and its risk factors among the female attendees of sexually transmitted disease (STD) clinics in Zhejiang Province, China. A self-administered questionnaire survey of a cross-sectional design was administered to attendees at four STD clinics in 2007. Of the 313 female STD clinic attendees, 42.5% reported that they had at least one unintended pregnancy; the induced abortion rate was 39.0%. Over their lifetime, 12.1% responded “use condoms always/often” and 5.4% “always/often used oral contraceptives.” The risk factors for the unintended pregnancy identified by the multivariate analysis were as follows: being married, experience of nonconsensual sex, and a history of STD, having two and over two sexual partners. Unintended pregnancies and induced abortion by female STD clinic attendees have reached an alarming prevalence. Doctors at STD clinics should attach importance not only to the STD problem of the female attendees, but also to the unintended pregnancy and the associated factors. Targeted contraceptive counseling and intervention should be promoted at STD clinics as a strategy to improve the efficiency and effectiveness of the reproductive health services in China.

Prevalence of unwanted pregnancy in Iran: a systematic review and meta-analysis

INTRODUCTION

Different studies show that a considerable number of pregnancies are unwanted and can have side effects on mothers'' children's and finally society's health. Accordingly, this meta-analysis study has been carried out to estimate a relatively accurate level of unwanted pregnancies in Iran.

METHODS

Present studies and published documents were retrieved from Persian and English electronic databases. To increase sensitivity and to select more studies, the reference list of the published studies was checked. After studying the titles and texts of documents, repeated and irrelevant ones were excluded. Data was analyzed using STATA V.11.

RESULTS

Forty-nine qualified papers were selected with a 43,061 sample size. The meta-analysis of unwanted pregnancy prevalence in Iran equals 30.6% (CI = 28.1-33.1). Also' according to the present meta-analysis' the most common contraceptive methods used by couples prior to unwanted pregnancies are as follows: pills 27.1%' withdrawal 38.6%' IUD 11.4%' injection contraceptives 2.8%' vasectomy 0.28% and no method 24.5%.

DISCUSSION AND CONCLUSION

The results of meta-analysis showed that about one-third of pregnancies in Iran are unwanted and a high percent of them are among women who had used contraceptives. Therefore' it is necessary to adopt more appropriate policies on the following: education, proper pregnancy age, using contraceptive methods, men's role in family planning programs and quality promotion in family planning services.

Prevalence of and some factors relating with unwanted pregnancy, in ahwaz city, iran, 2010

We aimed to find the prevalence and some factors relating with unwanted pregnancy. Methods. It was a cross-sectional study on 400 randomly pregnant women, who were referring to different health centers in Ahwaz city during 2010. Data was conducted based on questionnaire, and all the analysis was performed using SPSS (version 17) statistical analysis software. Results. The prevalence of unwanted pregnancy was 26%. The percentage of unwanted pregnancy in ages more than 35 years was approximately three times more than the intended pregnancy. There were significant relationship between unwanted pregnancy and some variables such as age, number of pregnancy, number of childbirth, education status, economic status, husband's occupation, and the relationship with the spouse and contraceptive methods (P < 0.0001). Conclusion. The prevalence of unwanted pregnancy was high. To prevent unwanted pregnancy using consultation services before planning to be pregnancy, it is necessary to identify the factors relating with unwanted pregnancy.

Sexual dysfunction after a first trimester induced abortion in a Chinese population

OBJECTIVE

To evaluate the short-term effect of a first trimester induced abortion on sexuality in a Chinese population.

STUDY DESIGN

This is a cross-sectional study. One hundred and four women attending the post-abortion clinic 3-4 months after a first trimester induced abortion were recruited. They completed a self-administered questionnaire anonymously. The associations of various factors with sexual behavior after abortion were analyzed by the Chi-square test.

RESULTS

More than 30% of the women reported a reduction in both frequency of vaginal intercourse and sexual desire. Their partners also had a reduction in sexual desire. The reduction of vaginal intercourse is more significant among young, unmarried women and those not having sterilization (P=0.01). In addition, the prevalence of reduction in sexual desire and enjoyment among those women who had repeated abortion was significantly higher (P<0.01).

CONCLUSION

The sexuality of both women and their partners are affected after abortion. It may be due to both psychological trauma and the worry of another unwanted pregnancy. Proper counseling may relieve their anxiety and improve sexual lives.

Repeat induced abortions and contraceptive practices among unmarried young women seeking an abortion in China

OBJECTIVE

To determine the rates of repeated abortion and contraceptive use among unmarried young women seeking an abortion in China.

METHODS

We used an anonymous self-administered questionnaire at abortion clinics in Beijing, Changsha, and Dalian from January to September 2000.

RESULTS

Of 4547 unmarried young women seeking an abortion, 33.0% reported having had one previous induced abortion. Of those who had had more than one abortion, only 29.7% used a contraceptive method at their first sexual intercourse after the procedure; and of the 446 women who chose contraception, 41.3% used the traditional methods of withdrawal or rhythm. Although 65.0% of the young women had used condoms at least once, only 9.6% did so consistently and correctly; 47.7% of the current pregnancies were associated with nonuse of any contraceptive, and 52.3% were related to contraceptive failure.

CONCLUSION

The rate of unmarried young women seeking repeated abortions was high in China on 2000. The rate of consistent condom use was low, and the rate of contraceptive failure was higher.

Miscommunication between healthcare providers and patients may result in unplanned pregnancies

Our objective was to examine the impact of prior healthcare provider counseling on previous use of contraception and knowledge of emergency contraception in women seeking surgical abortion. We performed a retrospective analysis of 342 patient charts from women seeking an office abortion in a private practice setting from January 1999 to June 2001. Data extracted included demographic information, primary method of contraception over the preceding few months, compliance with that method, contraceptive history, knowledge of emergency contraception and postabortion contraception. Patients were primarily white (69%) and unmarried (63%) and had private insurance that covered abortion services (72%). Only 19% of women were using a birth control method with no recognized potential failure. Twenty-two percent of women were using their birth control method correctly but experienced an event that put them at risk for pregnancy, 32% were using their birth control method incorrectly and 27% were using no birth control method at all. Miscommunication between patients and their healthcare provider(s) negatively affected use of a primary contraceptive method in 14% of patients. Of the 77% of women who did not know about emergency contraception, nearly two thirds had an identifiable event for which emergency contraception could have been used. Healthcare providers may contribute to the occurrence of unintended pregnancy if they provide poor medical advice or miscommunicate with patients.

Caractéristiques des utilisatrices de pilule du lendemain, en France

OBJECTIVES

Emergency contraception pill (ECP) has recently become available in France without prescription since 1999. The aim of this study was to explore knowledge, attitudes toward, and use of ECP.

PATIENTS AND METHODS

A national sample of 1639 women were interviewed by telephone randomly selected from the telephone directory. After sending a letter to each household to minimize the number of refusals, finally 397 eligible women aged 18-44 years accepted to answer.

RESULTS

Seventy-one percent of women know ECP and 9% had ever used ECP. ECP users were younger, more often single, but no important difference was found with education level, religion and knowledge of ECP between users and non-users. Only 25% of the women knew the exact correct time for using it (within 72 h following an unprotected sex). ECP users had more sexual partners in their life (12 vs. 4, P < 0.05) and 27% vs. 8%, had a previous history of sexual transmitted disease (P < 0.01). ECP users had a different contraceptive profile than non-users; they used less effective methods but the frequency of contraception use was found to be higher. Finally, over 1 year, the percentage of potential ECP users can be estimated at 13% considering women who had reported problems with condom use, forgot their pill once or more.

DISCUSSION AND CONCLUSION

ECP users are different from non-users, but all women are concerned and should receive increased education on ECP use. Making ECP more easily available in population may reduce the rate of unintended pregnancy.

Contraceptive use before and after marriage in Shanghai

Data from a cohort study of 7,336 newly married fertile couples conducted between 1987 and 1995 were used to analyze contraceptive method choice, switching, and discontinuation in two districts of Shanghai. Twelve percent of couples reported that they had had sexual intercourse before marriage. Only one-third of those exposed to premarital risk of conception were protected by some form of contraception, mostly by withdrawal and periodic abstinence. As a consequence, a majority of these couples conceived, prompting rapid marriage in most cases and induced abortion among one-fourth of them. After marriage, about half of the couples used contraceptives to postpone the birth of their first child, but of these, 40 percent experienced an unintended pregnancy. Method choice was dominated by condoms, withdrawal, and abstinence. After the birth of their first child, almost all couples (98 percent) adopted contraceptives, but one-third of them used ineffective methods. Failure and discontinuation rates were high, giving rise to a high incidence of induced abortion. Increasing numbers of couples switched to the IUD, and this was the preferred method for the majority by the third year following childbirth. These results suggest that wider method choice that includes hormonal contraceptives should be provided to meet couples' needs in Shanghai and that the family planning program's attention should be focused specifically on sexually active unmarried individuals and on the availability of postpartum services.

Artificial Contraception is Associated with Increased Numbers of Induced Abortions

Since the sexual revolution, it has been a widely accepted fact that contraceptives have been a necessity for our society. They seem to be the best way to prevent unwanted pregnancies that would otherwise result from sexual unions between two people unprepared for the commitment of raising any or additional children. It almost goes without saying that the more effective and available contraceptives become, the less likely women who wish to avoid pregnancy will become pregnant and the fewer induced abortions they will seek. In reality, the information available concerning abortions and the women who obtain them points to a different conclusion. The more effective and available contraceptives become in a society, the more widespread the practice of induced abortions becomes. On the other hand, natural family planning has been associated with fewer induced abortions when an unplanned pregnancy results. This paper will present a sample of the information available, attempt to draw conclusions, and discuss the possible reasons that contraceptives are unavoidably linked to increasing numbers of induced abortions and that, conversely, natural family planning is associated with very few or no induced abortions.

The Impact of the National Family Planning Programme on the Quality of Care in China

During the past 10 years studies conducted on the quality of family planning services have examined the strengths and weaknesses of family planning in many developing countries. China's national family planning programme in the past two decades has achieved extremely successful benchmarks, and accelerated the pace of fertility transi tion. It is one of the world's most closely watched family planning programmes, often sparking intense debates about reproductive behaviour and reproductive rights. This study evaluates a variety of elements on the quality of family planning services by analysing survey data and historically reviewing the development of China's national family planning programme. The author argues that the quality of family planning services in China is influenced greatly by the national family planning policy and its implementation at the grassroots level. In particular, quality of care refers to the ser vice network, service resources, service strategic interventions and provider-client relationships. China's family planning programme is undergoing a shift from tradi tional services to comprehensive services in reproductive health, and is gradually insti tutionalising the quality of care. Although the cost of personal freedom in reproductive behaviour should be taken into consideration, this study provides evidence that China's national family planning programme has exerted a relatively positive impact on the quality of care for the world's largest population.

Emergency contraception: a review of the programmatic and social science literature

Many biomedical aspects of emergency contraception have been investigated and documented for >30 years now. A large number of social science questions, however, remain to be answered. In this article, we review the rapidly growing but geographically lopsided literature on this topic. Using computer database searches supplemented by reference reviews and professional correspondence with those active in the field, we gathered literature on the social science and service delivery aspects of emergency contraception published in English up through December 1998, as well as a few unpublished papers from the same time and slightly later, representing regions where published material is practically nonexistent. Methodologically acceptable papers are summarized in our tables and text, and form the basis for suggested improvements in existing emergency contraceptive services. The review also offers ideas for designing new emergency contraception services where they do not yet exist. We conclude by proposing an agenda for further social science research in this area.

An international study on the acceptability of a once-a-month pill

Totals of 450 women attending family planning clinics in Hong Kong, Shanghai and Edinburgh, and 468 in Cape Town, completed a questionnaire designed to seek their views on a contraceptive pill which would be taken only once each month. At least two-thirds of the women in all centres liked the idea of a once-a-month pill. In Hong Kong, Cape Town and Edinburgh, women preferred a pill which inhibited ovulation to one which inhibited implantation, while in all centres a pill which worked after implantation (early menstrual inducer) was considered unacceptable by over half the women. A pill which was taken after a missed menstrual period was considered preferable in all centres, perhaps because it would not be used every month but rather only if pregnancy had occurred. No demographic characteristics, contraceptive experiences or beliefs were consistently correlated with attitudes towards a once-a-month pill, except that women who would not consider having an abortion were more likely to dislike a method that either prevented, or worked after, implantation. A once-a-month pill is now technically possible, although the major drawback is the need to determine when it should be taken. It is reassuring that many women from a variety of different cultures and with widely different experiences, would find this an attractive approach to contraception.