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Purpose: To understand the associations between awareness, attitudes, and intentions to use long-acting reversible contraceptives (LARCs) among youth seeking induced abortion services in Shanghai, China., Materials and Methods: A cross-sectional survey was carried out among 1,215 nulliparous youth with unintented pregnancies in 41 hospitals of Shanghai, China, through a stratified sampling process between January and May 2019. Multivariable logistic regression was used to test the associations between awareness, attitudes and intentions to use LARCs., Results: Around 70% of youth had heard of at least one method of LARCs. About 38% of youth perceived that the copper-bearing intrauterine contraceptive device (Cu-IUD) was safe; the rate was 8% and 7%, respectively, for levonorgestrel-releasing intrauterine system (LNG-IUS) and subdermal implants. Less than 40% of youth thought Cu-IUD was effective in contraception, and it was around 6% for LNG-IUS and subdermal implants. Overall, less than 8% of youth expressed intentions to use LARCs. Positive attitudes towards LARCs were highly associated with the intentions to use LARCs [adjusted Odds Ratio (OR) 3.22, 95% confidence interval (CI) 1.96-5.42, p  < 0.001]., Conclusions: Low awareness and negative attitudes towards LARCs were found in this study, and the negative attitudes towards LARCs could contribute to low intentions to use LARCs among youth who had already experienced unintended pregnancies.

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.

Objective: The objective was to determine the level of awareness and usage of emergency contraception (EC) among pregnant teenagers., Study Design: A cross-sectional survey was conducted through face-to-face interviews using a structured questionnaire, which was distributed to 600 pregnant teenagers with an unwanted pregnancy who requested an abortion at the MCH and general hospitals in Shanghai. Before the interview, the interviewer provided a short explanation of the purpose of the study and of EC, and then collected information on the respondent's previous awareness, usage, and reason for failure., Results: The average age of the participants was 17.86+/-0.99 years. Almost half (49.1%; 290/591) had experienced contraception failure and almost all (99.3%; 587/591) had already had sex without any contraception in the past. Backup "methods" previously used included EC in 36.1% (110/305), urinating in 32.1% (98/305), showering in 15.4% (47/305), vaginal douching in 10.5% (32/305), and jumping up and down in 5.9% (18/305). Almost half (47.7%; 282/591) of the girls had heard of EC; among them 44.0% (124/282) had already used it at least once within the 6 months before the pregnancy. Almost all (91.4%; 540/591) of the girls had used no contraception, 8.6% (51/591) had experienced contraception failure within the pregnancy cycle, but only 8.3% (49/591) had actually used EC. Among the latter, 81.6% (40/49) correspond to user failure, the other 18.4% (9/49) to method failure. Girls who were aware of EC were more likely to use a contraceptive method, and were less likely to have sex without any contraception (P<0.01), but were not more likely to use unreliable contraception (P>0.05)., Conclusions: Both advocacy of EC and the awareness of the risk of unprotected sex should be improved through sex education programs in schools in China. Pharmacists, being the main EC providers in direct contact with sexually active adolescents, should receive systematic training and take the responsibility for offering information about the correct usage of EC and other, more reliable contraceptive methods.

Background: A combination of mifepristone and misoprostol provides an effective method of medical abortion for early pregnancy. A new route of administration of misoprostol, the sublingual route, was investigated in this study., Methods: One hundred women who requested legal termination of pregnancy up to 63 days were given 200 mg of oral mifepristone followed 48 h later by 800 microg (4 x 200 microg tablets) of sublingual misoprostol., Results: Ninety-four women (94%) had a complete abortion with this regimen. There was one ongoing pregnancy. The median duration of vaginal bleeding was 15 days. There were no serious complications. However, lower abdominal pain, diarrhoea, chills and fever were the commonest side-effects with incidences of 89, 42, 38 and 79% respectively., Conclusions: The combination of mifepristone and sublingual misoprostol is effective for medical abortion up to 63 days gestation. Randomized trials are required to compare its efficacy and side-effect profile with vaginal misoprostol.

Background: A prospective randomized placebo controlled trial was performed to assess the immediate use of oral contraceptive (OC) on the amount of blood loss in the post-abortion period in women undergoing medical abortion by mifepristone and misoprostol., Methods: One hundred women were randomized by computer to receive either OC pills or placebo, immediately after medical abortion., Results: There was no difference in the complete abortion rate between the two groups. The complete abortion rate was 98 and 92% in the OC and placebo groups respectively. The side-effects and duration of bleeding were also similar. The median days of vaginal bleeding were 17 (range: 3-41) and 15 (range: 5-48) in the OC and placebo groups respectively. There was a statistically significant decrease in the mean haemoglobin level on day 15 in the OC group (from 12.0 to 11.5 g/dl) whereas the mean haemoglobin level in the placebo group remained stable. The median measured blood loss was 69.9 ml in the OC group and 72.8 ml in the placebo group and there was no statistically significant difference between the two groups., Conclusion: We conclude that it is safe to offer women combined OC pills immediately after medical abortion as an option of contraception, as it does not affect the duration or amount of vaginal bleeding or the complete abortion rate.