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| Start time and influence factor of postpartum contraception: a cross-sectional study in 15 provinces in China |
| 1. Maternal and Child Health Care Hospital of Changning Distirct, Shanghai, 200051; 2. Key Lab. of Reproduction Regulation of NHFPC, SIPPR, IRD, Fudan University; 3. School of Public Health, Fudan University |
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Abstract Objective: To investigate start time and determinants of postpartum contraception in China for providing scientific evidences for postpartum contraception education. Methods: From July 2017 to January 2018, a cross-sectional study was conducted at 60 hospitals in 15 provinces of China. In each hospital, 300 postpartum women who had gave births between July 2015 and June 2016 were randomly selected and interviewed. Answers on women's start time of postpartum contraceptive used, resumption of sexual activity after childbirth, return of postpartum menses of included women were recorded. Frequency, percentage distribution, life-table method and multilevel multivariable Cox regression model were used in data analysis. SAS 9.4 and MLwiN 2.5 software were used for data analysis. The level of significance was set to be 0.05 (2-tailed). Results: The cumulative probabilities of postpartum contraception starting at the 3-, 6-, 9- and 12-month after childbirth were 18.5%, 63.1%, 81.7%, and 85.0%, respectively, which were lower than those (24.1%, 73.6%, 91.1%, and 93.8%, respectively) of postpartum resumption of sexual activity starting at corresponding time. The start time of postpartum resumption of sexual activity and that of postpartum contraception was positively correlated (Pearson correlation coefficent was 0.76). The median start time of postpartum contraception was 4 months after childbirth (P25=3, P75=9). Results of multilevel Cox regression analysis show that women's age, nationality, education, number of children, method of child delivery and length of breastfeeding were significantly associated with the start time of postpartum contraception. Conclusion: The start time of contraceptive used in Chinese postpartum women is generally later than their resumption of sexual activity after childbirth. Contraceptive education and family planning counselling should be universally provided to Chinese postpartum women, in particular to the young women with low socioeconomic status, women who have resumed their sexual activity without menstruation recovery, and those women who have breastfed for a long time.
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