Document Type

Article

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Background: Premarital sex has become more acceptable in China nowadays. The Chinese Family Planning (FP) programme mainly focuses on married couples, and young unmarried women have little access to information or advice about contraception. Abortion is commonly used to end unintended pregnancies in China. This study aimed to determine risk factors related to repeat abortions in Chinese adolescents.

Methods: This cross-sectional study was one component of an EU-funded project and was conducted between March 20, and Oct 5, 2013 in China. We collected data using a questionnaire filled by abortion service providers for all women seeking abortions within 12 weeks of pregnancy during a period of 2 months in selected hospitals. A total of 297 hospitals were randomly selected across 30 provinces using a stratified cluster sampling design according to the level and type of hospital. In this study, only the adolescents (younger than the minimum legal married age of 20 years for women, unintendedly pregnant) were included for analysis. All participants signed a written informed consent of which they received a copy. Ethics approvals were obtained from both ethics committees of the National Research Institution for Family Planning (NRIFP), China, and of the Ghent University, Belgium.

Findings: Of the 2370 adolescents (median age 19 years, range 13–19), 927 (39%) were undergoing repeat abortions, 206 (9%) for a third time or more. The primary reason for their unintended pregnancies was non-use of contraception (1609, 68%), followed by ineffective contraception (761, 32%). After adjusting for potential confounding factors, the adolescents who had an increased risk of repeat abortions were those who had children (OR 2·63, 95% CI 1·82–3·78), those who resided in a middle-developed region (1·79, 1·30–2·48), those who resided in a relatively poor region (2·37, 1·77–3·17), and those who had used contraception during the 6 months preceding the survey (1·34, 1·08–1·65 for condom use). Adolescents who were students had a lower risk of repeat abortions than did those who were not students (0·69, 0·54–0·88).

Interpretation: Repeat abortions among adolescents are highly prevalent in China. Adolescents should be offered equal access to FP in China to that of married women to reduce unintended pregnancies and repeat abortions. Correct and consistent contraception practice among adolescents should be promoted.

Funding: The European Commission under the Seventh Framework Programme (FP7): INtegrating Post-Abortion Family Planning Services into China's existing abortion services in hospital setting (INPAC), 282490.

Publication

Lancet

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