Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis

Hu, Denghui; Tang, Yu-Wen; Pei, Kaiyan

doi:10.3389/ijph.2023.1605564

Cited by 2 publications

(1 citation statement)

References 41 publications

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“…Additionally, the China Maternal and Child Health Association is implementing a project to provide government-funded post-abortion care (PAC) services, involving over 900 hospitals in 2022, to promote couples' contraceptive behaviours through counselling, education and one-to-one guidance. 11 However, the effectiveness of these initiatives in improving contraceptive practices and preventing unintended pregnancies and subsequent abortions has yet to be thoroughly validated.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021

Tu,

Hu,

et al. 2024

BMJ Sex Reprod Health

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IntroductionDespite the widespread provision of free contraceptives and post-abortion care (PAC) services, China grapples with a high rate of unintended pregnancies and subsequent abortions. We aimed to study the evolving characteristics of women seeking abortion and their contraceptive practices before and after abortions, to shed light on the optimisation of Chinese PAC services.MethodsThis study utilised data from an abortion cohort between 2019 and 2021. We studied their demographic features, contraception and abortion histories, reasons and choices using chi-square or linear-by-linear tests. We also explored the potential impact of receiving services at PAC facilities on post-abortion contraception use and repeat abortions using logistic regression models.ResultsAmong the 9005 participants, 43.4% experienced repeat abortion, without a discernible trend over the 3 years. Noteworthy increases were observed in the percentages of college students (from 1.7% to 6.6%, p<0.01) and middle-aged women (from 23.2% to 26.8%, p<0.01) seeking abortions. Surgical abortion was chosen by nearly 90% of participants with a continuously increasing trend (ptrend<0.01). Nearly half of the participants experienced unintended pregnancies due to non-use of contraception. Of the remainder, the majority preferred less or the least effective methods both before and after abortion. Women residing in moderate-gross domestic product (GDP) regions faced a higher risk of repeat abortions (OR 1.33, 95% CI 1.16 to 1.54). Despite this, high-quality PAC services may encourage the use of reliable contraceptive methods, with 86.8% of women changing from least effective or no methods to (most) effective methods post-abortion, and prevent repeat abortions (OR 0.65, 95% CI 0.56 to 0.75).ConclusionsIncreased proportions of college students and middle-aged multiparous women seeking abortions were observed, together with inappropriate preferences for less effective contraception and increasing choice of surgical abortions. Future research should extend the focus to cover the entire abortion period, advocate the rational selection of contraceptive methods, and emphasise the specified PAC services tailored to different socioeconomic groups.

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Section: Introductionmentioning

confidence: 99%

Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021

Tu,

Hu,

et al. 2024

BMJ Sex Reprod Health

Self Cite

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Successful strategies that address gender-related barriers and promote bodily autonomy within efforts to scale up and sustain post-pregnancy contraception: A scoping review

Castro,

Kabra,

Coates

et al. 2024

Preprint

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IntroductionAcknowledging the integral role of bodily autonomy in advancing gender equality, our study aimed to assess the extent to which strategies used in postpartum and post-abortion contraception have effectively equipped women, girls, and gender-diverse individuals with the tools, knowledge, and resources required to make autonomous decisions that align with their diverse life experiences.MethodsWe conducted a scoping review using the databases PubMed, EBSCOhost, EMBASE, and SciSpace. We included implementation, evaluation, and experimental studies published in any language between 2013 and 2023 and excluded studies not meeting these criteria. We used a WHO scale to determine the level of gender responsiveness.ResultsWe found 30 implementation, evaluation, and experimental studies published in any language between 2013 and 2023. We categorized the strategies as gender-transformative (4 studies), gender-specific (24 studies), and gender-sensitive (2 studies). None of the studies reported strategies hindering reproductive health and rights. All strategies involved women and girls, and none explicitly targeted gender-diverse people capable of childbearing.ConclusionGender-transformative strategies shared a commitment to empowering women with the autonomy to make informed decisions about post-pregnancy contraception through a) delivering personalized counseling that respected each woman’s reproductive goals and ensured privacy during these discussions; b) integrating the cultural and familial context of women’s health decisions; and c) promoting a rights-based approach that prioritized informed consent and defended women’s reproductive rights. These interventions were delivered in contexts of quality improvement strategies integrating contraception services into the continuum of post-pregnancy care, offering women continuous access to information. Gender-specific strategies focused on informed contraceptive decision-making while recognizing the potential impact of gender dynamics on contraceptive use without actively challenging the underlying gender norms or power relations. Gender-sensitive strategies, although indicated gender awareness, did not address the process of informed contraceptive decision-making nor emphasize the provision of supportive environments that respect and enhance bodily autonomy.KEY MESSAGESWhat is already known on this topicPrevious scoping and systematic reviews have explored strategies to increase post-pregnancy contraception uptake globally. However, none have specifically focused on strategies that promote bodily autonomy while addressing gender-related barriers. Our study addresses this gap by providing a comprehensive understanding of such strategies and their impact on scaling up and sustaining post-pregnancy contraception.What this study addsThis study provides new insights by being the first scoping review to focus on strategies promoting bodily autonomy in addressing gender-related barriers to scaling up and sustaining post-pregnancy contraception. The gender-transformative strategies reported in the studies shared a commitment to empowering women with the autonomy to make informed decisions about post-pregnancy contraception through a) delivering personalized counseling that respected each woman’s reproductive goals and ensured privacy during these discussions; b) integrating the cultural and familial context of women’s health decisions; and c) promoting a rights-based approach that prioritized informed consent and defended women’s reproductive rights.How this study might affect research, practice, or policyThis study highlights the importance of integrating gender-transformative activities into post-pregnancy contraceptive strategies. It underscores the necessity of understanding and addressing local gender norms and the broader health system context to effectively promote bodily autonomy. The findings suggest that success should not be solely measured by contraceptive uptake but also by how well interventions address gender-related barriers. Future research should focus on developing and validating indicators that evaluate these barriers and promote bodily autonomy, ensuring comprehensive strategies that truly empower women, girls, and gender-diverse individuals with the means, abilities, and assets to make informed choices that resonate with the broader spectrum of their lives.

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Strategies for Improving Postpartum Contraception Compared With Routine Maternal Care: A Systematic Review and Meta-Analysis

Cited by 2 publications

References 41 publications

Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021

Characteristics and contraceptive practices among Chinese women seeking abortion: a multicentre, descriptive study from 2019 to 2021

Successful strategies that address gender-related barriers and promote bodily autonomy within efforts to scale up and sustain post-pregnancy contraception: A scoping review

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