Prevalence of unintended pregnancy and its associated factors among sexually active never-married youth in Shanghai

Knowledge, attitude and practice of contraceptive methods among women with an unplanned pregnancy

OBJECTIVES

The study aimed to investigate the knowledge, attitude and practice (KAP) of contraceptive methods among women with an unplanned pregnancy, aiming to improve their reproductive health and increase their understanding of contraceptive methods.

DESIGN

This is a cross-sectional study.

SETTING

The study was conducted at the Maternity and Child Healthcare Hospital of Hubei between 20 November 2022 and 20 January 2023.

PARTICIPANTS

Women with an unplanned pregnancy were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

The questionnaire was in the Chinese language and included demographic data, KAP assessments. Multivariate linear regression was performed to explore the factors associated with knowledge or practice scores.

RESULTS

During the study period, 510 participants with valid questionnaires were included. The KAP scores were 7.30±2.91, 32.61±3.13 and 28.58±3.59, respectively. Place of residence (urban vs non-urban; B=0.66, 95% CI 0.02 to 1.29, p=0.043) and educational level (master's degree or above vs post secondary or below; B=1.07, 95% CI 0.17 to 1.96, p=0.020) were positively associated with knowledge. Knowledge (B=0.25, 95% CI 0.17 to 0.32, p<0.001) and attitude (B=0.26, 95% CI 0.19 to 0.32, p<0.001) were positively associated with practice.

CONCLUSIONS

This study indicates a low level of KAP regarding contraceptive methods among women facing unplanned pregnancies. Place of residence and educational level were positively associated with knowledge scores. These findings may help improve future sex education policies and programmes.

Induced abortions among Chinese adolescent girls

BACKGROUND

Induced abortion among adolescent girls is a global public health issue and a serious challenge in China, but still remains under-examined. We aimed to examine the overall trend and characteristics of induced abortions among Chinese adolescent girls and to investigate the factors associated with induced abortion.

STUDY DESIGN

Based on the 2017 China Fertility Survey, this study examined the trend and characteristics of induced abortions among adolescent girls with statistical analysis and multiple indicators of descriptive statistics from period and cohort perspectives, including induced abortion proportion and rate, age-specific cumulative proportion, and age-specific cumulative number of induced abortions in adolescent girls.

RESULTS

Between 1996 and 2016, the proportion and rate of adolescent induced abortions first increased and then decreased, and the mean age at the time of induced abortions among adolescent girls declined. The cumulative proportion of women who had experienced induced abortion at the age of 15-19 in a cohort is less than 2.5% but shows an upward trend. Over 70% of all adolescent induced abortions are premarital. The proportion of women with unintended pregnancy experiences increased and is higher among rural, less educated, and ethnic minority women. Similarly, the prevalence of induced abortion is higher among adolescent girls who live in rural areas, are less educated, and come from ethnic minorities. The cumulative number of induced abortions and premarital abortions increased with later cohorts.

CONCLUSIONS

This study shows an upward trend in adolescent-induced abortion and a decline in the age at the time of the induced abortion. Women in later birth cohort have a higher proportion of having experienced adolescent induced abortion. Adolescent girls who live in rural areas, who are less educated, or who are from ethnic minorities, are more likely to undergo induced abortions at the age of 15-19. More appropriate educational efforts and interventions are urgently needed to reduce the incidence of adolescent induced abortions.

Burden and Trend of Macrosomia and Large-for-Gestational-Age Neonates Attributable to High Pre-Pregnancy Body Mass Index in China, 2013-2017: A Population-Based Retrospective Cohort Study

Background: The world is transitioning to an obese future, but few studies have measured the burden of increased maternal body mass index (BMI) on pathological fetal overgrowth, especially the trends in this burden and its heterogeneity in populations with different characteristics. Methods: A population-based retrospective cohort study was conducted with 7,998,620 Chinese females who had participated in the National Free Pre-Pregnancy Check-ups Project and became pregnant during 2013-2017. The proportions of macrosomic and LGA neonates attributable to high BMI (population attributable fraction, PAF) and annual percent change of yearly PAFs were estimated. Results: We found that the burden of macrosomic and LGA (large-for-gestational-age) neonates attributable to high pre-pregnancy BMI increased among Chinese females with planned pregnancies during 2013-2017. The PAF of macrosomia attributable to high BMI increased from 3.16% (95% confidence interval: 2.97-3.35%) to 7.11% (6.79-7.42%) by 23.60% (16.76-30.85%) annually, and the PAF of LGA increased from 2.35% (2.21-2.48%) to 5.00% (4.79-5.21%) by 21.98% (16.14-28.11%) annually. Our study identified that participants with disadvantaged socioeconomic status (including those without higher education, living in provinces with GDP per capita < 40,000 CNY, tier IV, and tier V cities) and residing in northern and southwestern China were at high risk of a rapidly expanding burden. Conclusions: Government authorities should control pre-pregnancy BMI through nationwide intervention programs and direct more resources to focus on the unfair burden on females with disadvantaged socioeconomic status.

Recent trend and correlates of induced abortion in China: evidence from the 2017 China Fertility Survey

BACKGROUND

Although there are more than 10 million induced abortions per year in China, there are few comprehensive, systematic, and characteristic-based data on induced abortions among Chinese women. This study aims to examine the overall trend in induced abortions in China and to analyze the correlation between induced abortions and some socio-economic factors.

METHODS

Drawing from the 2017 China Fertility Survey, this study analyzed induced abortions using multiple indicators from period and cohort perspectives on a sample of 240,957 women. The indicators include the abortion rate and proportion, average age at the time of induced abortion, age-specific cumulative proportions, and the number of induced abortions by cohort. The analysis also differentiated based on residency, ethnicity, education level, and marital status. A binomial logistic regression model was used to examine the association between induced abortions and socio-economic factors.

RESULTS

Between 2006 and 2016, among women aged 15-49, there was an increase in the induced abortion rate and the average age of women who had induced abortions, but a decline in the proportion of abortions. The proportion of induced abortion was higher among premarital than post-marital pregnancies, among unintended than planned pregnancies. Women with induced abortion experiences accounted for less than 30% of all cohorts, and the cumulative number of induced abortions per woman in each cohort was less than 0.45. These indicators varied with birth cohort, residence, ethnicity, education level, and marital status. The results of binomial logistic regression confirmed the association between induced abortion and these socio-economic variables. Sex-selective abortions of female fetuses still exist, despite the government's considerable efforts to eliminate them.

CONCLUSION

The practice of induced abortions differs by cohort and socio-economic characteristics. The profile of women who resort to abortions in China has shifted from well-educated urban women to rural, less-educated women. More effective measures should be taken by the government to reduce the number of induced abortions among women with higher abortion risks.

Contraceptive and reproductive health practices of unmarried women globally, 1999 to 2018: Systematic review and meta-analysis

BACKGROUND

Premarital sex practices and contraceptive prevalence rate (CPR) among unmarried women worldwide remain unclear, even though unmarried women tend to have multiple sex partners over time, which makes their sexual behaviors particularly important to the sexual and reproductive health of society more broadly.

METHODS

We searched the MEDLINE, PubMed, and Google Scholar databases for relevant articles published between January 1, 1999 and December 31, 2018. Data on prevalence of premarital sexual intercourse, use of highly prevalent contraceptive methods, as well as CPR overall and at first sexual intercourse were extracted and estimated using a DerSimonian- Laird random effects model.

RESULTS

Of the 3918 articles identified, 37 covering 19 countries were included. The estimated overall prevalence of premarital sexual intercourse was 41.9% (95%CI 34.2-49.6%). Pooled CPR was 57.0% (95%CI 44.3-69.8%) overall and 57.6% (95% CI 39.5- 75.6%) at first intercourse. The overall prevalence of condom use was 51.2% (95%CI 42.7-59.7%), followed by oral contraceptives (20.5%, 95%CI 13.7-27.3%), withdrawal (12.7%, 95%CI 9.4-15.9%), and rhythm (12.1%, 95%CI 6.7-17.4%).

CONCLUSION

The findings of this global study indicate worrying trends in unprotected intercourse and contraceptive practices, suggesting the need for greater attention and resources aimed at educating unmarried adolescent women about sexual and reproductive health.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42019132736.

Sexual Knowledge, Attitudes and Behaviours among Undergraduate Students in China-Implications for Sex Education

BACKGROUND

Despite rapid modernization and improving gender equity in China in recent decades, traditional values prevail in many areas of life, including sexual behavior. This study aimed to explore gender differences in sexual knowledge, sexual attitudes and sexual behaviors, as well as preferences for sex education among undergraduates in China.

METHODS

A cross-sectional study surveyed 5965 undergraduates (62.8% females), aged 15 to 24 years from nine universities in Zhejiang, Henan and Yunnan provinces, from September to November 2019.

RESULTS

Of the total sample, 158 (2.6%) self-identified as homosexual, 287 (4.8%) as bisexual and 324 (5.4%) stated they were unclear about their sexual identity. The mean sexual knowledge score out of 12 was 6.16 ± 2.54 points. Ever having sexual intercourse was reported by 18.7% (27.0% males, and 13.9% females). Students from urban backgrounds, and those with homosexual and bisexual orientation were more likely to have had sexual intercourse. Most students (72.5%) reported that they would prefer to receive sex education from on-line sources.

CONCLUSIONS

Female students are significantly more conservative in sexual attitudes and sexual behaviors. Low levels of sexual knowledge contribute to risk behaviors among Chinese adolescents. China needs to develop and widely disseminate on-line sex education, with practical, age-appropriate content.

Unmarried Youth Pregnancy, Outcomes, and Social Factors in China: Findings From a Nationwide Population-Based Survey

Introduction

Early pregnancies and their poor reproductive outcomes remain increasing concerns.

Aim

This study aims to investigate the pregnancy rate and outcomes and to identify social factors associated with pregnancy among Chinese unmarried youths aged 15–24 years.

Methods

Data were obtained from the Survey of Youth Access to Reproductive Health in China, and 11,076 unmarried female youths were analyzed. Prevalence of pregnancy by various demographic and socioeconomic characteristics was calculated. Univariate and multivariable logistic regression models were used to identify factors associated with pregnancy.

Main Outcome Measure

The main outcome is pregnancy among unmarried female youths during their lifetime.

Results

Among 11,076 female youths, 501 individuals reported 697 premarital pregnancies during their lifetime until the survey was conducted, approximately 62.9 (95% CI: 58.5–67.6) pregnancies per 1,000 female youths. Older age group (odds ratio [OR] = 4.49; 95% CI = 3.60–5.59), low education levels (primary school and below: OR = 1.78, 95% CI = 1.33–2.37; junior and senior high school: OR 1.44, 95% CI = 1.15–1.80), living in non-eastern regions (central: OR 1.34, 95% CI = 1.06–1.68; west: OR 1.62, 95% CI = 1.28–2.04), cigarette smoking (OR 3.60, 95% CI = 2.76–4.70), alcohol drinking (OR 1.59, 95% CI = 1.28–1.97), from family with mother’s education of primary school and below (OR 1.65, 95% CI = 1.11–2.46), and the bottom economic status (OR 1.48, 95% CI = 1.14–1.91) were associated with higher risk of premarital pregnancy among female youths.

Conclusion

The findings justify the national concern for pregnancy among unmarried youth in China. Strategies to improve sexual education in school and family, to enhance the reproductive services for youth, and to increase public awareness of the reproductive health of young people were warranted.

Guo C, Pang L, Ding R, et al. Unmarried Youth Pregnancy, Outcomes, and Social Factors in China: Findings From a Nationwide Population-Based Survey. Sex Med 2019;7:396–402.

Male Experience and Sociodemographic Characteristics of Premarital Pregnancy: Based on a Nationwide Population-Based Survey Among Urban and Rural Chinese Youths

Little is known about the male experience of premarital pregnancy (MEPP) and the sociodemographic characteristics of unmarried male youths involved in pregnancy. This study estimates the prevalence of MEPP and identifies the sociodemographic factors associated with it among Chinese unmarried youths aged 15–24 years, using data from the Survey of Youth Access to Reproductive Health in China. Descriptive analyses and χ² tests were applied to explore the number and prevalence of MEPP, and logistic regressions were used to identify the associated factors. As a result, among 2,853 sexually experienced male youths, 597 individuals reported 852 partner pregnancies caused by them during their lifetime, with a weighted prevalence rate of 20.87% (95% CI [18.85%, 22.88%]). Among these pregnancies, 78.05% ended in induced abortion. Factors like living with only the father (OR: 4.16, 95% CI [2.22, 7.8]) and the low level of education of the father (junior high school or below, OR: 1.60, 95% CI [1.04, 2.46]) were associated with MEPP among unmarried male youth. Furthermore, there is a marked difference between the rural and urban youth in factors associated with MEPP. The findings in this study highlight the importance of and need for strategies and interventions targeting male youths, in order to improve sexual education and reproductive services.

Contraceptive practices among unmarried women in China, 1982-2017: systematic review and meta-analysis

OBJECTIVE

Premarital sexual practices and contraceptive prevalence rate (CPR) among unmarried women in China remain unclear. We conducted a systematic review and meta-analysis to estimate CPR and analyse contraceptive methods used by unmarried women between 1982 and 2017.

METHODS

Wanfang, The China National Knowledge Infrastructure Database, MEDLINE, PubMed and Web of Science were systematically searched. Data on CPR and use of major contraceptive methods were extracted and pooled using a DerSimonian-Laird random effects model.

RESULTS

Of 188 articles retrieved from five databases, 22 studies met our inclusion criteria. Overall CPR based on a random effects meta-analysis was 32.2% (95% confidence interval [CI] 24.7%, 39.8%). Pooled rates of contraceptive use were 61.4% (95% CI 47.9%, 74.9%) for condoms, 25.9% (95% CI 14.5%, 37.4%) for pills, 19.8% (95% CI 8.9%, 30.8%) for the rhythm method and 25.4% (95% CI 14.2%, 36.7%) for the withdrawal method.

CONCLUSIONS

The sexual and reproductive health situation of unmarried women in China seems to have improved little since the 1990s. Our findings may help to optimise reproductive health care programmes and thereby reduce the alarming rates of unplanned pregnancies and abortions among unmarried women in China.

Gender Differences in Sexual Behaviors in Korean Adolescents

PURPOSE

The purposes of this study were to identify whether there are gender differences in sexual behaviors among Korean adolescents and to explore the factors that influence safe sex practices across both sexes.

METHODS

A secondary analysis was conducted using nationally representative data obtained from the 2014 Youth Risk Behavior Web-based Survey. Sample consisted of 3,210 adolescents who had experience of sexual intercourse. The dependent variable in this study was practicing safe sex. The independent variables included a range of individual, family, and school factors.

RESULTS

Female adolescents were less likely to practice safe sex (i.e., always using a condom). Individual (smoking, no drinking before sexual intercourse), family (living with parents, higher allowance per week) and school factors (non-coeducational school students, had received school-based sex education) were significant predictors of practicing safe sex in males. In contrast, family (lower economic status) and school factors (middle school students) predicted practicing safe sex among female adolescents.

CONCLUSION

We demonstrated that gender plays an important role in the sexual behavior of adolescents. The findings of this study indicate a need to design and implement gender-specific interventions.

Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case-Control Study

Objective

To evaluate the association between the risk of ectopic pregnancy (EP) and the use of common contraceptives during the previous and current conception/menstrual cycle.

Methods

A multi-center case-control study was conducted in Shanghai. Women diagnosed with EP were recruited as the case group (n = 2,411). Women with intrauterine pregnancy (IUP) (n = 2,416) and non-pregnant women (n = 2,419) were matched as controls at a ratio of 1∶1. Information regarding the previous and current use of contraceptives was collected. Multivariate logistic regression analyses were performed to calculate odds ratios (ORs) and the corresponding 95% confidential intervals (CIs).

Results

Previous use of intrauterine devices (IUDs) was associated with a slight risk of ectopic pregnancy (AOR₁ = 1.87 [95% CI: 1.48–2.37]; AOR₂ = 1.84 [1.49–2.27]), and the risk increased with the duration of previous use (P₁ for trend <10⁻⁴, P₂ for trend <10⁻⁴). The current use of most contraceptives reduced the risk of both unwanted IUP (condom: AOR = 0.04 [0.03–0.05]; withdrawal method: AOR = 0.10 [0.07–0.13]; calendar rhythm method: AOR = 0.54 [0.40–0.73]; oral contraceptive pills [OCPs]: AOR = 0.03 [0.02–0.08]; levonorgestrel emergency contraception [LNG-EC]: AOR = 0.22 [0.16–0.30]; IUDs: AOR = 0.01 [0.005–0.012]; tubal sterilization: AOR = 0.01 [0.001–0.022]) and unwanted EP (condom: AOR₁ = 0.05 [0.04–0.06]; withdrawal method: AOR₁ = 0.13 [0.09–0.19]; calendar rhythm method: AOR₁ = 0.66 [0.48–0.91]; OCPs: AOR₁ = 0.14 [0.07–0.26]; IUDs: AOR₁ = 0.17 [0.13–0.22]; tubal sterilization: AOR₁ = 0.04 [0.02–0.08]). However, when contraception failed and pregnancy occurred, current use of OCPs (AOR₂ = 4.06 [1.64–10.07]), LNG-EC (AOR₂ = 4.87 [3.88–6.10]), IUDs (AOR₂ = 21.08 [13.44–33.07]), and tubal sterilization (AOR₂ = 7.68 [1.69–34.80]) increased the risk of EP compared with the non-use of contraceptives.

Conclusion

Current use of most contraceptives reduce the risk of both IUP and EP. However, if the contraceptive method fails, the proportions of EP may be higher than those of non-users. In the case of contraceptive failure in the current cycle, EP cases should be differentiated according to current use of OCPs, LNG-EC, IUDs, and tubal sterilization. In addition, attention should be paid to women with previous long-term use of IUDs.