Trends and determinants of contraceptive method choice in China

Contraception promotion is a crucial component of family planning programme in China. The state strategy has been gradually shifted from largely relying on mass mobilization and administrative means to client-centred informed choice since mid-1990s. Data are drawn from six national population and family planning surveys conducted during 1982-2006. Data from all six surveys are used for describing the trends in contraception use and method mix change over the last three decades. Individual level data from the 2001 and 2006 surveys are applied to investigate the effect of changing strategies on parity-specific methods uptake. Both individual and community level data from the 2006 survey are then used to examine the determinants of informed choice. Separate logistic multilevel models are fitted for each of the two outcomes. The contraceptive prevalence rate among married women of reproductive age in China was over 70 percent in the 1980s and reached 80 percent since 1990s. There was then a shift towards increased condom use and a decrease in sterilization among “new users” between 1996-2001 and 2001-2006. The multilevel analysis shows significant reductions in the uptake of methods encouraged by government programme between 1996-2001 and 2001-2006. The community contraception provision plays a positive role for informed choice. Although the historical top-down approach towards promoting long-acting methods has been weakening over time, the institutional pressure on individuals remains influential for the method choice. Enhancing community contraception provision and providing adequate counselling could significantly benefit informed contraceptive and in turn, could contribute to improving women’s reproductive health