ICRH Kenya

PAFP CHINA: Post Abortion Family Planning Services in China

PARTNERS

  • International Centre for Reproductive Health (ICRH) Ghent University Belgium
  • National Research Institute for Family Planning (NRIFP) Bejing China
  • Hennan Provincial Institute for Family Planning (HNPIFP) Hennan China
  • Shangaï Da Cheng Institute of Health (SDC) Shangaï China
  • University of Amsterdam/Amsterdam School for Public Science Research (ASSR/Uva) Amsterdam Netherland
  • Danish Epidemiology Science Centre (DESC) Aarhus Denmark

OBJECTIVES

General objective

  • To define optimal ways to introduce post-abortion family planning services in urban areas in China in order to increase contraceptive use after induced abortion and subsequently reduce the rate of unwanted pregnancies and repeat abortion rate.

Specific objectives

  • To carry out a literature review and a situation analysis regarding the current availability, acceptability and use of PAFP in urban areas in China and to better understand the underlying reasons of the high repeat abortion rate.
  • To develop two different types of PAFP (a minimal package versus a comprehensive package), both well adapted to the specific Chinese cultural and socio-economic context as well as a model for their introduction into urban Chinese health services, including training of abortion service providers.
  • To implement and monitor the two different types of intervention (minimum versus comprehensive package PAFP) in three large Chinese cities.
  • To assess knowledge, attitudes and existing practices regarding PAFP among abortion service providers and to appraise changes before and 1 year after the introduction of PAFP in the abortion clinics.
  • To explore and critically appraise changes in quantity and quality of PAFP and counselling provided to the women in both intervention groups.
  • To measure the effectiveness of both types of intervention through measuring and comparing the adherence to and correct use of contraceptives among young women 6 months after they had an induced abortion, before and after introduction of PAFP in those clinics
  • To assess the knowledge and attitudes regarding contraception and determinants of abortion, among women who had an induced abortion and appraise the impact of introducing PAFP on women’s knowledge and attitudes.
  • To regularly observe, monitor and describe the integration process of both interventions, their impact on clinic regulations as well as the costs related to both interventions and the problems encountered during the implementation.
  • To draft conclusions regarding the feasibility, acceptability and cost-effectiveness of different models of PAFP introduced in urban area’s in China and to disseminate the results nationally and internationally.

ACTIVITIES AND METHODOLOGIES

The project took place in three large cities in China: Beijing, Shanghai, and Zhengzhou. 

Three main activities took place during the three years of duration of the project:

  • In the first year (2005), a qualitative research has been undertaken and two different models of family planning services to be integrated in abortion services have been developed.

    The qualitative research was done in 25 hospitals of Beijing, Shanghai, and Zhengzhou.  Previous to the research, staff was trained in qualitative research methods.  The methodological tools used included observation, in-depth interviews (IDI), key informant interviews, and focus group discussion (FGD).   The study was done in nine hospital offering abortion in Beijing, eight in Shanghai, and eight in Zhengzhou (Annex 1- The target group, places and times of the qualitative study in three cities).  To start off, listing and ranking exercises were done with women seeking abortion in each hospital. This was followed by the observation of the services as well as of women and their partners who came to the hospital for abortion.   In Beijing   81 women seeking abortion were interviewed, 80 in Shanghai, and 85 in Zhengzhou respectively. The following focus group discussions were conducted: six with service providers, six  with women seeking abortion services under the age pf 25, six with  women over the age of 25 seeking abortion service and six with the  intimate male partners of women seeking abortion service. In each area key informant interviews were done with six heads of Gynecology and Obstetrics, six   principals of abortion clinic, 12  medical staff members of Gynecology and Obstetrics, In-depth interviews were afterwards done with 30 women seeking abortion service in each hospital – this happened both pre-abortion and post-abortion, In depth interviews were also done with 12  intimate male partners of women seeking abortion service.

  •    In the second year (2006),  a cluster randomized trial comparing two models of integrating PAFP services has been performed in  three cities

    A total of 24 hospitals from three cities of China were paired and randomly assigned to either of the two intervention packages: A and B. Package A included provision of limited information and referral to existing family planning services, and Package B included face-to-face counseling, provision of free contraceptive methods, and male involvement, in addition to Package A. Women seeking abortion at these hospitals were interviewed at the time of the abortion and six months later. At the interview six months later, women were asked about use of contraceptive methods and abortion during the follow-up period.

 

  • In the third year (2007), the outcome of the intervention has been assessed.  Quantitative data collected before and after the intervention were compared.

    A structured questionnaire has been used for the data collection; data were collected twice, before randomization and after implementation of the intervention, respectively.   The primary indicators were (a) use of contraceptives [use of any contraceptive methods, including condom, natural methods, IUD, contraceptive pills, emergency oral contraceptives, sterilization, injection, implant, diaphragm, spermicides, etc], (b) use of effective contraceptives (use of condom, contraceptive pills, IUD, and implants), (c) consistent use, correct use, and both consistent and correct use of condoms among condom users (d) no neglect among contraceptive pill users, (e) Pregnancies among all follow-up women, (f) unwanted pregnancies including induced abortion during the follow-up period and unwanted ongoing pregnancies for which women did not want to give birth to a baby among all follow-up women and (g) Repeat induced abortions among all follow-up women during the follow-up period.  For the analysis, a conditional logistic regression accounting for hospital matching to calculate odds ratios for all the primary indicators was used. The comparisons have been done between Package A and package B as well as between pre-intervention and post- intervention among package A and package B, by taking into account the cluster effect (hospital).

RESULTS

The results demonstrated that an essential intervention Package A, (group education and referral to existing family planning services), increased the use of any contraception after abortion and the consistent and correct use of condom. A comprehensive intervention Package B ( individual counseling, provision of free contraceptive methods,  limited male involvement,) in addition to Package A,  had a much stronger effect on couples’ behavior change in use of contraception after abortion and the  consistent and correct use of condom.  A comprehensive approach in family planning services may be superior to a simple approach for increasing use of effective contraceptive methods and user adherence among abortion-seeking couples in China.

PUBLICATIONS

International publication

 

– The making on an absent woman. The Chinese state and the sexually active unmarried female. D. Gibson, J. Xu, Y. Cheng, X. Xu, J. Zhu, M. Temmerman, F. WuillaumePublished in:. Identity, Culture and Politics: An Afro-Asian dialogue. Vol: 2007:1-21

Published articles in Chinese

– Cai yamei, Cheng yimin, Lv yanhong, et al. The study on the necessity of Post Abortion Family Planning Service (PAFPS) for the floating abortion women. Chinese journal of family planning, 2006,8:472-474.

– Cheng yimin, et al. From the induced abortion to the spread of contraceptive usage. Journal of Practical Obstetrics and Gynecology, 2007,20(9):588-590.

– Lv yanhong, Li ying, Guo xin, et al. Cross-sectional Research of Sexual Behavior and Contraceptive Use among Young Women Seeking Abortion in Beijing. Chinese journal of women-child health care, 2007, 22(21): 2955-2958.

– Cai yamei, Cheng yimin, Lv yanhong,et al. The necessity of post abortion family planning service in china. Model preventive medicine,2007,34(12):2255-2257.

– Wang xiaoyan, Cheng yimin, Cai yamei,,et al. The effect of male factor on contraceptive use among induced abortion women in Beijing. Chinese journal of family planning, 2007,6:345-348. – Wei hong, et al. Influential factor study on health service utilization of floating population with RTIs. Chinese journal of family planning, 2007,11. – Zhang peiyu, et al. Situation on post-abortion service of health providers in hospitals. Maternal and child health care journal of China, 2007,22(27):3839-3843.

Paper ready to be  submitted for publication

– Integration of family planning with abortion services in three cities of China: a cluster randomized trialJin Liang ZHU1, Wei-Hong Zhang2, Yimin CHENG3, Juncai XU4, Xiao XU5, Diana GIBSON6, Henrik STØVRING7, Marleen Temmerman2

Papers further do be developed for submission to international journals

– Attitudes and Practice of Post Abortion Family Planning among abortion service provider in three cities of China-PAFP project, leader author:  Zhang WH (ICRH team, Belgium)

– Why women seek abortion in three cities of China, leader author: YM Cheng (Beijing, team, China).

– The characteristics of women seeking abortion in three cities of China-PAFP project, leader author, ZC Xu (Shanghai team, China).

– Attitudes and Practice of Post Abortion Family Planning among women seeking abortion in three cities of China

-PAFP project, leader author, XM Chang ( Zheng zhou team, China).

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