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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.

AbstractTo explore the rate and influencing factors of unmet need for postpartum family planning (PPFP) in China. We conducted a retrospective cohort study at 60 hospitals in 15 provinces that were in eastern, central, and western regions of China. Participants were women who delivered a live birth at the study sites with an interval of 13 to 24 months between delivery and interviews. We selected participants using cluster randomization approach, and the first 300 postpartum women who gave a birth at each study hospital after the initial month that had been selected were interviewed. Information on the women's background characteristics, pregnancy history, time when menstruation and sexual activity resumed after childbirth, the adoption of contraceptive method, breastfeeding, and any pregnancy or pregnancy outcome after delivery were collected. We performed life-table analysis to estimate the rate of unmet need for PPFP and a 2-level logistic regression model to explore factors that influence unmet need for PPFP within the first 24 months postpartum. A total, 19,939 postpartum women were screened in this study, of which, 17,466 (87.6%) were eligible for this analysis. The rates of unmet needs for any FP methods were 23.9% (95% confidence interval [CI] 23.3–24.6%), 11.8% (95%CI 11.3–12.3%); 10.6% (95%CI 10.1–11.1%) at 6, 12, and 24 months postpartum; these rates for modern FP methods were 35.5% (95%CI 34.7–36.2%), 25.6% (95%CI 24.9–26.2%), and 24.6% (95%CI 23.9–25.2%), respectively. Results of 2-level logistic regression analysis showed that less-educated young women, those who had only one child or delivered by vaginal delivery at secondary hospitals, were associated with increased risk of unmet need for PPFP. Approximately 31% of women who had unmet need for PPFP reported a pregnancy during the first 24 months postpartum, which was significantly higher than the level for their counterparts (10.0%). The level of unmet need for PPFP in China was high, resulting in a high pregnancy rate within 24 months after delivery. Women's age, education level, prior pregnancy and abortion histories, and delivery method were significantly associated with the risk of unmet need for PPFP. National PPFP guidelines that integrate PPFP services into prenatal and postnatal care are urgently needed and should be implemented throughout the country as soon as possible. PPFP services should promote the use of modern contraceptive methods.