Effects of multilevel postpartum family planning intervention on the reduction of unintended pregnancy and induced abortion rates within 12 months of delivery: a cluster randomized controlled study in China

Yuyan Li; Yan Zhang; Dong Yuan; Li Shan; Xiaojing Dong; Liqun Wang; Yuanzhong Zhou; Weixin Liu; Xiaojun Wang; Lifang Jiang; Xiaoyu Hu; Wei Xia; Xiaochen Huang; Jiandong Song; Liangping Wang; Li Jiang; Hanfeng Ye; Yanfei Zhou; Yan Che

doi:10.1016/j.contraception.2024.110753

Effects of multilevel postpartum family planning intervention on the reduction of unintended pregnancy and induced abortion rates within 12 months of delivery: a cluster randomized controlled study in China

Contraception. 2024 Nov 17:110753. doi: 10.1016/j.contraception.2024.110753. Online ahead of print.

Authors

Yuyan Li¹, Yan Zhang¹, Dong Yuan², Li Shan³, Xiaojing Dong⁴, Liqun Wang⁵, Yuanzhong Zhou⁶, Weixin Liu⁷, Xiaojun Wang⁸, Lifang Jiang⁹, Xiaoyu Hu¹⁰, Wei Xia¹¹, Xiaochen Huang¹², Jiandong Song¹³, Liangping Wang¹⁴, Li Jiang¹⁵, Hanfeng Ye¹⁶, Yanfei Zhou¹⁷, Yan Che¹⁸

Affiliations

¹ NHC Key Lab of Reproduction Regulation, Shanghai Engineering Research Center of Reproductive Health Drug and Devices, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, Chin.
² Tianjin Hedong District Obstetrics and Gynecology Hospital, Tianjin, China.
³ Department of Gynecology and Obstetrics, Northwest Women and Children's Hospital, Xi'an, China.
⁴ Department of Obstetrics and Gynecology, Second affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁵ Jiangxi Maternal and child Health Hospital, Nanchang, China.
⁶ School of public health, Zunyi Medical University, Zunyi, China.
⁷ Key Laboratory of Reproductive Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, China.
⁸ Human sperm bank, Urumqi Maternal and Child Health Care Hospital, Urumqi, China.
⁹ NHC Key Laboratory of Birth Defects Prevention, Institute of Reproductive Health, Henan Academy of innovations in medical Science, Zhengzhou, China.
¹⁰ Department of Women's Health, Shanghai Center for Women's and Children's Health, Shanghai, China.
¹¹ Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹² Department of Gynecologic, Fujian Women and Child Health Hospital, Fuzhou, China.
¹³ Department of Obstetrics and Gynecology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China.
¹⁴ Department of Obstetrics and Gynecology, Jiangmen Maternal and Child Health Hospital, Jiangmen, China.
¹⁵ Department of Gynecological Endocrinology & Reproductive Surgery, Guangxi Maternal and Child Health Hospital, Nanning, China.
¹⁶ Yunnan Population and Family Planning Research Institute, Kunming, China.
¹⁷ Women's Health Center, Changsha Hospital for Maternal and Child Health Care, Changsha, China.
¹⁸ NHC Key Lab of Reproduction Regulation, Shanghai Engineering Research Center of Reproductive Health Drug and Devices, Shanghai Institute for Biomedical and Pharmaceutical Technologies, Shanghai 200237, Chin. Electronic address: cheyan2004@163.com.

PMID: 39561868
DOI: 10.1016/j.contraception.2024.110753

Abstract

Objectives: To evaluate the effects of a multilevel postpartum family planning (PPFP) intervention on the reduction of unintended pregnancies and induced abortions in China.

Study design: We performed a cluster randomized intervention study to assess the effects of a multilevel PPFP intervention on the rates of unintended pregnancy and induced abortion within 12 months postpartum. Thirty-six hospitals were included and randomly allocated to two groups at a 1:1 ratio, enrolling 180 pregnant women per hospital starting in January 2019. The intervention included integrated contraceptive education and counseling at three critical stages, namely, the third trimester, delivery, and several postpartum time points. We used life table and multilevel Cox regression for data analysis.

Results: We recruited 6,315 participants, namely, 3,116 in the intervention group and 3,199 in the control group. The 12-month cumulative rates of unintended pregnancy and induced abortion were significantly lower in the intervention group (2.74% [95% CI, 2.16-3.46] and 1.43% [95% CI, 1.01-2.03], respectively) than in the control group (6.99% [95% CI, 6.00-8.14] and 3.85% [95% CI, 3.09-4.79], respectively). Multilevel Cox regression revealed a 63% reduction in the risk of unintended pregnancy (HR 0.37 [95% CI, 0.19-0.71]) and a 67% reduction in the risk of induced abortion (HR 0.34 [95% CI, 0.16-0.69]) in the intervention group.

Conclusions: This multilevel PPFP intervention was effective in reducing the risk of unintended pregnancy and induced abortion within the first year after childbirth. We recommend scaling up this approach to other hospitals across the country that provide prenatal educational classes and postpartum contraceptive services.

Clinical trials: ChiCTR1900023790.

Keywords: China; Cluster randomization; Induced abortion; Intervention effect; Postpartum family planning; Unintended pregnancy.