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.