Unintended pregnancy and induced abortion
The overall 12-month rates of pregnancy, unintended pregnancy, and induced abortion are 6.3%, 5.3%, and 4.0%, respectively; indicating that 84% of all pregnancies conceived during the first 12 months postpartum were unintended, and 75% (accounting for 63% of all pregnancies) were terminated by abortion procedures. By 24 months postpartum, the cumulative rates of pregnancy, unintended pregnancy, and induced abortion increased to 18.5%, 13.6%, and 10.8%, respectively; 77% of pregnancies were unintended; and 76% of unintended pregnancies ended in abortion. Intriguingly, several local studies reported even higher risks of unintended pregnancy. For instance, investigators using a survey in Enshi, Hubei Province, estimated that 10% of women underwent an unintended pregnancy during the first 12 months postpartum.(13) Ruo et al. estimated that 9% of postpartum women had an unintended pregnancy within 12 months after childbirth in Pengshan District, Sichuan Province.(21)According to an official report, a total of 17.23 million babies were delivered in China in 2017.(22) If we posited that these babies were all singleton births, based on our estimates there would be approximately 1 million pregnancies conceived within 12 months postpartum in women who gave a birth in 2017. Of these pregnancies, 913,000 were unplanned and 689,000 would have ended in abortion. The direct medical expenses for abortion services (1500 Yuan per abortion surgery) are approximately 1 billion Yuan (about 14 million USD). These results demonstrated that the first 12 months after childbirth constituted an essential period for women to take contraceptives so as to prevent an unintended pregnancy and induced abortion in China. Our findings indicated an urgent need for revising the current national PPFP program with clearer guidance on counselling postpartum women regarding LARC methods in China.