Postpartum contraception
The present study revealed that between 86% and 87% of postpartum
women used at least one contraceptive method during the first 12 and 24
months after childbirth, respectively. Our findings were similar to that
of a US study, in which, 88% of postpartum women used contraceptive
methods in 12 states and New York City.(17) In our
study, 73% of contraceptive initiators adopted modern methods during
the first 24 months postpartum, which was similar to the finding of the
2006–2010 National Survey of Family Growth in the United States (76%
at 18 months postpartum).(5) However, our estimate was
higher than the results from most low- and middle-income
countries—e.g., 10% in Ethiopia, 25% in Niger and Ghana, 34% in
India,(6) and 65-70% in Indonesia.(18)
Unexpectedly, we found that by 12 months postpartum, 26% of respondents
who had resumed sex had an unmet need for contraception. Previous
studies showed that the levels of unmet need for postpartum
contraception were very high in most low- and middle-income countries;
e.g., 33%–38% in Indonesia,(18) 52% in
Nepal,(19) 32% in India, 46% in Kenya, 59% in
Nigeria, and 97% in Pakistan.(6) It is important to
note that the definition of “unmet need” varied among studies. We
defined unmet need for postpartum contraception as women who resumed sex
after delivery, but did not use any contraceptive methods or used
traditional methods. Dev et al. in a systematic review defined unmet
need for postpartum contraception based upon the data available, e.g.,
as women who did not want a child in the subsequent two years but also
were not using modern contraceptives. (6)Contraceptive methods are free for married couples in China, and
unmarried couples can also readily receive free short-acting methods
from family planning service points. Hence, the high level of unmet need
for postpartum contraception may largely reflect inadequate PPFP
services during the process of prenatal and postnatal care in China.
Condoms accounted for 79% of the first postpartum contraceptive
choices; followed by traditional methods (16%). IUDs accounted for only
3%, and no participants underwent sterilisation or used contraceptive
implants. This specific mix of contraceptive methods was very different
from findings reported elsewhere. For example, 28% of US women used
hormonal contraceptives, 11% underwent female sterilisation, 2% of
male partners underwent sterilisation, 6% used LARC methods, and 25%
used less effective methods (including condoms, spermicides, and
traditional methods) at 3 months postpartum.(5) Using
this classification, only 3% of postpartum women initiated the use of
highly effective contraceptive methods in our study. Although a
substantial number of short-acting method users switched to IUDs during
the extended postpartum period—making IUDs (14%) the second commonly
used contraceptive methods at the time of interview—condom use
predominated (75%). According to a WHO document, when used in typical
fashion, the effectiveness of condoms, withdrawal, and periodic
abstinence is about 87%, 80%, and 77%, respectively—all far below
that for LARCs (IUDs, 99%; implants, 99.9%).(20) The
mixed use pattern of postpartum methods therefore raises concerns of an
elevated risk of unintended pregnancy and induced abortion among
postpartum Chinese women.