Effects of post-abortion family planning services on preventing unintended pregnancy and repeat abortion (INPAC): a cluster randomised controlled trial in 30 Chinese provinces

Abstract

BackgroundAround 10 million induced abortions are conducted annually in China; a third of the women having had those abortions have undergone repeat abortions. Most abortions are performed in hospital settings in which post-abortion family planning (PAFP) services are often lacking. This study aims to evaluate the effects of integrating PAFP services into abortion services on the reduction of unintended pregnancy and repeat abortion in China. MethodsThis was a three-arm cluster (hospital) randomised controlled trial. Study participants were women undergoing an abortion within 12 weeks of pregnancy. 90 hospitals were selected from 30 Chinese provinces and allocated randomly (1:1) into two intervention groups or one control group. Intervention group 1 included provision of family planning information, contraceptive counselling, involvement of the male partner, and free provision of contraception; intervention group 2 included incentive mechanisms for health-care providers in addition to group 1; and the control group received normal care, with no intervention. Eligible women were followed up for 6 months. The primary outcomes were the rates of unintended pregnancies and repeat induced abortions. We used a three-level random intercept model to estimate the effects of intervention using a generalised linear mixed model, and we used SAS PROC GLIMMIX with maximum likelihood with Laplace approximation to perform this multilevel modelling approach. This study received ethical approval from the Ethical Committees at Ghent University, Belgium, on May 26, 2014 (B670201421116), and from the National Research Institute for Family Planning, China, on March 6, 2014. All participants provided a Chinese written informed consent. This trial has been registered at International Standard Randomised Controlled Trial, number ISRCTN01846583. FindingsWe recruited 17 235 eligible women from July 11, 2014, to Aug 20, 2015. The intervention 1 group included 5856 women, intervention 2 group included 5791 women, and the control group included 5588 women. The proportion of patients who were followed up for up to 6 months were similar in the three groups (74·7% [4372 of 5856] in intervention group 1, 77·1% [4466 of 5791] in intervention group 2, and 75·7% [4231 of 5588] in the control group). The proportion of patients with unintended pregnancy within 6 months after abortion was lower in both intervention groups (1·2% [59 of 5011] in group 1 and 1·2% [58 of 4986] in group 2) than in the control group (3·2% [155 of 4817]). The proportion of patients who had a repeat abortion was 0·9% (45 of 5011) for the intervention group 1, 0·8% (41 of 4986) for the intervention group 2, and 1·6% (77 of 4817) for the control group (ie, 16–38% lower in the interventions group than that in the control group). Statistical analysis is ongoing. InterpretationIntegrating post-abortion family planning services into hospital-based abortion services could decrease unintended pregnancy and repeat abortions. A policy and guidelines on integration of PAFP into routine abortion services is urgently needed to reduce the number of abortions. FundingEuropean Commission FP7 (282490).