Introduction
A short interpregnancy interval increases the risks of maternal and
infant mortality and morbidity. Early studies have shown that closely
spaced pregnancies are associated with adverse maternal and infant
outcomes.(1, 2) Family planning can prevent more than
30% of maternal deaths and 10% of child mortality when couples space
their pregnancies 2–3 or more years apart.(3) In
2013, WHO recognized postpartum family planning (PPFP) as one of the top
priorities with respect to global reproductive health
issues.(4)
Postpartum contraceptive use varies among countries. A previous study
showed that 72% of women used a contraceptive method by 3 months after
childbirth in the United States.(5) In 21 low- and
middle-income countries, the polled one-year contraceptive use rate for
modern methods was 41.2%. (6) Studies in Shanghai
showed that approximately 70% of migrant women in a suburban district
and 88% of those living in downtown used contraceptives in the first 12
months postpartum. (7, 8) Kang et al. found that only
66% of postpartum women in rural areas of Hunan Province adopted
contraceptive methods.(9) We did not uncover any
reports on overall postpartum contraceptive use nationwide in China.
Globally, an estimated 99 million unintended pregnancies occurred
annually between 2010 and 2014. Of them, 56% ended in induced abortion.(10) Ahrens et al. estimated that approximately 36%
of pregnancies conceived within 18 months postpartum in the United
States were unintended.(11) Moore et al. showed that
birth-to-pregnancy intervals in 50% or more of pregnancies in 21 low-
and middle-income countries were less than 23
months.(12) Xiao et al. demonstrated that 10% of
women of reproductive age in Enshi, Hubei province of China, experienced
unintended pregnancies during the first year after delivery.(13) None of them reported the prevalence of abortion
during postpartum period.
Approximately 10 million abortions (9.6–9.9 million in 2016–2018) are
performed each year in China.(14) Reducing the number
of abortions has been recognised by Chinese health authorities as one of
the major approaches to improving women’s reproductive health, and the
health administrators from both central and local governments and a
large number of family planning service providers have realised the
importance of PPFP services for postpartum women. However, our knowledge
of postpartum contraception, unintended pregnancy, and abortion across
China is still very limited. We therefore conducted the present
retrospective cohort study with the primary aim of exploring the
prevalence of unintended pregnancy in the extended postpartum period
(12–24 months after childbirth) in eastern, central, and western
regions of China. Our secondary aims included the investigation of the
prevalence of contraception and abortions during postpartum period. This
information is essential for designing appropriate interventional PPFP
strategies that will contribute to the reduction of unintended
pregnancies and induced abortions in China overall.