Effects of a community-based sex education and reproductive health service program on contraceptive use of unmarried youths in Shanghai

Abstract

Purpose To evaluate the effectiveness of a youth-friendly intervention in promoting one safe sex behavior—contraception and condom use among unmarried young people aged 15–24 years in Shanghai, China. Methods The study was conducted in two towns of a suburban area of Shanghai (one as the intervention and the other as the control), with comparable socio-cultural-economic and demographic characteristics. The intervention intended to build awareness and offer counseling and services related to sexuality and reproduction among unmarried youths, in addition to the routine program activities, which were exclusively provided in the control site. Baseline surveys were conducted in both sites before the implementation of the intervention, and similar surveys were conducted in both sites 20 months after the intervention had been initiated to test the feasibility and effectiveness of the intervention. In total, 1220 unmarried young people from the intervention site and 1007 from the control site, including 1304 out-of-school youths and 923 high school students, were recruited, and about 92% of them were successfully followed up. Four main measures were examined (i.e., ever contraceptive use, current regular contraceptive use, ever condom use, and contraceptive use at onset of sexual intercourse—if it occurred during the course of the intervention). The reasons for nonuse of contraceptives, the status of joint decision on contraception and the first method used were also assessed. Data were analyzed using Logistic regression models with dichotomous measures of contraceptive use and Generalized Estimating Equations (GEEs) with repeated measures. Results At baseline, there was no statistical difference in contraceptive use between the intervention and control groups. After intervention, the proportions reporting regular contraceptive use and condom use in the intervention group were much higher than that in the control group ( p < .001). A group × time interaction effect ( p < .0001) was found for regular contraceptive use and ever condom use. Logistic regression analysis with dichotomous measures of contraceptive use and GEEs with repeated measures showed similar results. The regular contraceptive use and ever condom use were correlated with subject's occupation and family economic status, respectively. After adjusting for demographic factors, the subjects from the intervention group were 14.58 (OR) times as likely to use contraceptives at onset of intercourse as those from the control group (95%CI: 8.55–24.87, p < .0001). Similar results were found for both females and males. Conclusions A multifaceted intervention program that provided information and skills, as well as counseling and services, appears to have positive influences on contraceptive practice and condom use among unmarried young females and males in suburban Shanghai.