Trends and Determinants of Contraceptive Method Choice in China

Contraception promotion is a crucial component of the family planning programme in China. Since the mid-1990s, state strategy has gradually shifted from demographic targets towards a client-centred, informed choice approach. Data for this study 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 changes in method mix over the last three decades. Data for individuals taken from the 2001 and 2006 surveys are applied to investigate the effect of changing strategies on parity-specific methods choices. Both individual and community level data from the 2006 survey are then used to examine the determinants of informed choice. Multilevel logistic regression models are fitted for each of the two outcomes. The results show that contraceptive prevalence rate among married women of reproductive age in China was over 70% in the 1980s and reached 80% in the 1990s, with the method mix dominated by sterilization and IUD. A shift towards increase in condom use and a decrease in sterilization was observed among new users between 1996–2001 and 2001–2006. The multilevel analysis shows that between 1996–2001 and 2001–2006, the proportion of users choosing methods “highly recommended” by providers of family planning services declined significantly. The provision of a mix of contraceptives by the community plays a positive role for informed choice. Although the historical top-down approach towards promoting long-acting methods has weakened over time, institutional forces continue to influence the method choices made by individuals. Enhancing community contraception provision and providing adequate counselling could benefit informed choice of contraception method and this, in turn, could contribute to improving women’s reproductive health.