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.

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.