Abstract
Post-abortion family planning (PAFP) has been proposed as a key strategy to decrease unintended pregnancy and repeat induced abortions. However, the accessibility and quality of PAFP services remain a challenge in many countries including China where more than 10 million unintended pregnancies occur each year. Most of these unwanted pregnancies end in repeated induced abortions. This paper aims to explore service providers’ perceptions of the current situation regarding family planning and abortion service needs, provision, utilization, and the feasibility and acceptability of high quality PAFP in the future. Qualitative methods, including in-depth interviews and focus group discussions, were used with family planning policy makers, health managers, and service providers. Three provinces—Zhejiang, Hubei and Yunnan—were purposively selected, representing high, medium and relatively undeveloped areas of China. A total of fifty-three in-depth interviews and ten focus-group discussions were conducted and analysed thematically. Increased numbers of abortions among young, unmarried women were perceived as a major reason for high numbers of abortions. Participants attributed this to increasing socio-cultural acceptability of premarital sex, and simultaneously, lack of understanding or awareness of contraception among young people. The majority of service stakeholders acknowledged that free family planning services were neither targeted at, nor accessible to unmarried people. The extent of PAFP provision is variable and limited. However, service providers expressed willingness and enthusiasm towards providing PAFP services in the future. Three main considerations were expressed regarding the feasibility of developing and implementing PAFP services: policy support, human resources, and financial resources. The study indicated that key service stakeholders show demand for and perceive considerable opportunities to develop PAFP in China. However, changes are needed to enable the systematic development of high quality PAFP, including actively targeting young and unmarried people in service provision, obtaining policy support and increasing the investment of human and financial resources.
Highlights
There is limited evidence on the health risks of repeat abortions, there is some evidence of increased risk of reduced fertility, complications and poor outcomes in future pregnancies, in addition to potential psychological impacts [1,2,3,4]
As one type of family planning service, post-abortion family planning (PAFP) services aim to “assist women to identify the family planning problems leading to the unintended pregnancy, and help them to develop strategies to prevent their reoccurrence” [9,10]
PAFP has been proposed as a key strategy to decrease unintended pregnancy and repeated induced abortions [9, 10]
Summary
There is limited evidence on the health risks of repeat abortions, there is some evidence of increased risk of reduced fertility, complications and poor outcomes in future pregnancies, in addition to potential psychological impacts [1,2,3,4]. A cross-sectional survey of hospital data from 30 provinces in 2013 found that of 79,174 women seeking abortions within 12 weeks of pregnancy, 37% were undergoing a second abortion, and 29% a third or subsequent abortion [8]. This suggests that whilst access to safe abortion is a critical reproductive right, preventing unintended pregnancy where possible through access to high quality contraceptive services is important to promote women’s health, in future pregnancies. PAFP has been proposed as a key strategy to decrease unintended pregnancy and repeated induced abortions [9, 10].
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