| In the world,abortion is still an important public health and social problem.There are approximately 99 million unintended pregnancies worldwide each year,and 56%of them are ended in abortion.It is estimated that about 35 abortions per 1,000 women of childbearing age worldwide.In recent years,there are more than 9 million induced abortions in China,and about 50%of them are repeated abortions.The management system are strictly and abortion services are standardized in China,induced abortion is effective and safe.But induced abortion,especially repeated induced abortions,would more or less influence on physical and mental health of women.Induced abortion is affected by a variety of factors.On social level,such as economic development,adjustment of fertility policies,changes of population structure,and popularity of health education,etc,might influence the local level of induced abortion.On individual level,such as age,marital status,education level,occupation,and contraceptive health knowledge,could influence the risk of induced abortion,and in turn affects the level of induced abortion in the entire society.Therefore,it would be great significance to understand the influencing factors of induced abortion from macro and micro perspectives,and it would be useful to formulate strategies to prevent induced abortion,reduce the harm of induced abortion,and improve the health level of women at childbearing age.In this study,we used official statistics data and survey data during different periods to analyze the current status of induced abortion in China and its influencing factors from both macro and micro perspectives.Part One:Tendency and future prediction analysis of induced abortion and its complications in China during the past 50 yearsObjectives:Analyze the trend of induced abortion and its complications,understand the relationship between induced abortion and family planning policy,and predict the level of induced abortion in the next few years.Methods:Collected the number of induced abortion from 1971 to 2018,the number of women at childbearing age from 1988 to 2018,the number of live births from 1990 to 2018,and the number of complications,such as uterine perforation,incomplete abortion and infection,caused by induced abortion from 2002 to 2018.Estimate the induced abortion rate,induced abortion and live-birth ratio,and the rate of complications caused by induced abortion in different years.Dynamic sequence analysis method was used to analyze the trend over time.Ordered sample clustering method was used to cluster the number of abortions and analyze the correlation between abortion and family planning policy.Auto regressive moving average model（ARIMA）was used to predict the number of induced abortion,induced abortion rate,abortion and live-birth ratio in China from 2019 to 2025.Results:The number of induced abortions from 1971 to 2019 ranged from 3.7 million to 9.7 million,it generally showed an upward trend with an average development rate of 101.96%;the number of induced abortions fluctuated greatly;it increased gradually from 1971,remained at peak between1980 and 1990,declined from 1991,and then remained stable after falling to a low point in 2000.Induced abortion rate from 1988 to 1998 was decreased significantly which the fixed-base development ratio decreased from 104.39%to 49.33%and remained stable after 1998;the average development speed of induced abortion rate was 98.53%.The fixed-base development ratio of induced abortion and live-births ratio decreased from 100.45%to 44.41%with an average development speed of 98.68%;induced abortion and live-birth ratio declined obviously from 1990 to 1997,peaked in 2014,and then increased slightly form 2015 to 2018.The complications incidence of induced abortion decreased from 27.40 per ten thousand to 12.3 per ten thousand,and stabilized at around 13 per ten thousand after 2008;the incidence of uterine perforation was low and stable which was fluctuated between 0.25 per ten thousand and 0.85 per ten thousand;the incidence of incomplete induced abortion also showed a decline trend from 2002 to 2008,and remained stable after 2008,the highest peak was 2002（23.96 per ten thousand）,and the lowest valley was 2008（10.48 per ten thousand）;the incidence of infections during induced abortion increased from 2002-2005（3.11 per ten thousand to 3.95 per ten thousand）,and decreased slightly after 2005（2.59 per ten thousand to 0.72per ten thousand）.It was classified into 3 stages which were corresponded to different family planning policy stages:1971 to 1979（limited birth policy formed and comprehensively promoted period）,1980-1994（implement of‘one-child policy’period）,and 1995-2018（adjusted and released of‘one-child’policy period）.Predicted by ARIMA,the number of induced abortion from 2019 to 2025 would relatively steady at 970 ten thousand（95%CI:741 ten thousand to 1199 ten thousand）;induced abortion rate would fluctuate at 28.25‰with the 95%CI between 21‰and 35‰;induced abortion and live-birth ratio would approximately be 58.30%with the 95%CI between 38%and 82%.Summaries:Induced abortion was fluctuated with the changes of family planning policy from 1971 in China,and the strong relationship is existing between them.In the next few years,induced abortions would be still huge with approximately 970 ten thousand each year and induced abortion rate at27‰.It was important to establish a standard and effective service system to increase the knowledge of reproductive health and use of contraception,to reduce the induced abortion rate.Part two:Analysis of induced abortion in differences regions and influenced factors in ChinaObjectives:Comparison the different of induced abortion in different region,and analysis the impact of region family planning policy,economic level,and urban population proportion on induced abortion.Methods:Collected the number of induced abortions,induced abortion rates,induced abortion and live-birth ratio,gross domestic product（GDP）,and urban population proportion of 31 provinces（city,autonomous region）in China from 2002 to 2018.Divided all provinces into 3 groups by GDP ranking,into 2 groups by the urban population proportion,and into 2 groups according for ethnic minority areas or not.The difference in the level of artificial abortion by different grouping methods is compared.Spearman rank correlation coefficient was used to prescript the relationship among GDP,proportion of urban population and induced abortion.Multiple linear regression was used to analyze the impact of GDP,urban population proportion and ethnic minority region family planning policy on induced abortion.31 provinces was clustered into different induced abortion level region by k-means cluster method according all induced abortion data from2002 to 2018,and compared the differences among different groups.Results:From 2002 to 2018,the rank correlation coefficients between GDP and induced abortion number were from 0.763 to 0.833,from 0.535 to0.796 between GDP and induced abortion and live-birth ratio,and below 0.4between GDP and induced abortion rate.The induced abortion rate and induced abortion and live-birth ratio were highest of developed region,followed middle economic level region,and the underdeveloped region were lowest.From 2002 to 2018,the rank correlation coefficients between urban population proportion and induced abortion number were from 0.205 to 0.375,from 0.475 to 0.686 between urban population proportion and induced abortion rate,and above 0.7 between urban population proportion and induced abortion and live-birth ratio with the expected in 2016.The induced abortion rate and induced abortion and live-birth ratio were higher in groups which the urban population proportion was more than 50%,while lower in groups with urban population proportion less than 50%.The induced abortion rate and induced abortion and live-birth ratio were lower in minority autonomous regions,while higher in non-minority autonomous regions.Multiple linear regression analysis shows that the main influence factor of number of induced abortions was the proportion of urban population.The induce abortion and live-birth ratio was mainly affected by whether it is an autonomous region or not,and the abortion rate was jointly affected by GDP,the urban population proportion and whether it is an autonomous region or not.31 provinces were clustered into 3 categories.Category I included 6 provinces（cities）which were at high levels of induced abortion,category II included11 provinces（municipalities and autonomous regions）which were at medium abortion level,and category III included 14 provinces（autonomous regions）which were with low induced abortion level.Compared the provinces in 3cluster groups and other groups,the trend was not exactly same.Summaries:Local induced abortion is affected by a variety of factors in China.Regional economic level,urban population population are positively correlated with the level of induced abortion.In the provinces where the family planning is loose,the level of induced abortion would be high.Preventive measures should be formulate based on local conditions.Part three:Repeat induced abortion and relevant factors among women seeking induced abortion in China:two cross-sectional studies under EU-funding programObjectives:Compare the different of repeat induced abortion（RIA）in two time-period over 10 years,and identify the associated factors of repeat induced abortion among women seeking induced abortion in China.Methods:The two cross-sectional surveys（2005-2007 and 2015-2016）separately involved 24 hospitals in 3 cities and 90 hospitals in 30 provinces（municipalities and autonomous regions）across the country.Women seeking induced abortion in sample medical institutions were involved in this study.Chi-square test and rank sum test were used to compare the demographic characteristics,repeated abortion proportion and reason of induced abortion in different groups.Propensity score matching（PAM）was used to adjust the proportion different of demographic characteristics（age,education,occupation,marriage and fertility status）abortion women in two survey periods.Zero-inflated negative binomial regression（ZNBI）was conducted to identify independent factors associated with RIA among induced abortion seeking women.Results:A total of 26,125 induced abortion women involved in this study,with 9,497 in the first survey and 16,628 in the second survey.The demographic characteristics of women seeking induced abortion were statistically significant different between two surveys（P<0.001）.Compared with women seeking for induced abortion in the second survey,the women were younger,more unmarried and childless,and with higher education.The proportion of RIA of two surveys were 44.97%and 51.54%,separately.While after PAM,the proportion of RIA during second survey was 60.28%which was significantly higher than that during first survey（P<0.001）.In zero model of ZNBI,women seeking induced abortion were more likely to have RIA during first survey(ORadjand 95%CI:13.932（8.396,23.119）,sames below).Compared with women with university education,women with college（0.460（0.306,0.691））,senior school（0.189（0.100,0.359））and junior school(0.117（0.046,0.299）education were more likely to have RIA.Compared with unemployed women,women in the service industry were at higher risk of RIA（0.193（0.069,0.535））.Married and childbearing women were at higher risk of RIA（0.310（0.198,0.485）and 0.083（0.054,0.127）,separately）.In counted model of ZNBI,induced abortion frequency during second survey was 91.9%（95%CI:87.9%,96.0%）of that during first survey.Compared with women under 20 years old,induced abortion frequency of women at 21-25 years old,26-30 years old,31-35 years old,36-40 years old,and over 40 years old were1.779（1.624,1.950）,2.547（2.309,2.809）,3.272（2.960,3.618）,4.011（3.618,4.448）,and 3.932（3.465,4.461）times,separately.Compared to women with university education,induced abortion frequency of women with collage education was 1.176（1.111,1.246）times,and women with other level educations were about 1.3 times.Excepting managers,the induced abortions frequency of women with other occupations were about 60%-95%comparing to unemployed women.Induced abortion frequency of married women was92.9%（87.9%,98.2%）comparing to unmarried women,while induced abortions frequency of those who have children is 1.171（1.098-1.249）times that of those who have no children.The reason of unintended pregnancy among women seeking RIA was significantly different between two survey（P<0.001）.Analyzed by raw data,the proportion of’contraceptive failure’（52.13%）in second survey was significantly higher than the proportion（51.32%）in first survey.While adjusted by PSM,the proportion of’contraceptive failure’（52.52%）in second survey was significantly lower than the proportion（56.83）in first survey.Whether adjusted by PSM or not,the proportion of both’don’t want contraception’and’sexual intercourse before contraception method was prepared’among all the reason of’uncontraceptive’in the first survey were more than 40%;while during the second survey,the proportion of’don’t want to contraception’was more than 75%,and the proportion of’sexual intercourse before contraception method was prepared’was no more than 20%.There was significant different of the reason of’uncontraceptive’between two surveys（P<0.001）.The difference of reasons of‘contraceptive failure’between two surveys was significant（P<0.001）.Both analyzed by raw data and PSM data,the top two reasons of‘contraceptive failure’in first survey were‘emergency contraception’and‘condom’,and the top two reasons were‘condom’and‘rhythm method’in second survey.Summaries:The proportion of RIA in China was lower than 10 years ago.Marriage and childbirth status,age,education level and occupation were the influencing factors of RIA.The reason of unintended pregnancy among women seeking RIA had changed now,and‘Do not want to contraception’and using condom or rhythm contraceptive method were the main reasons of RIA. |
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