Abstract
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.
Article PDF
Similar content being viewed by others
References
Brown, J., Li, B. and Padmadas, S. S. (2010). A multilevel analysis of the effects of a reproductive health programme that encouraged informed choice of contraceptive method rather than use of officially preferred methods, China 2003–2005. Population Studies, 64 (2): 105–115.
Bongaarts, J., and S. Sinding. (2011). Population policy in transition in the developing world. Science, 333:574–575.
Bruce, J. (1990). Fundamental elements of the quality of care: a simple framework. Studies in Family Planning, 21(2): 61–91.
Gu, B. C., Wang, F., Guo, Z. G., and Zhang E. L. (2007). China’s local and national fertility policies at the end of the twentieth century. Population and Development Review, 33(1): 129–147.
Hardee, W.K., Xie, Z. M. and Gu, B. C. (2004). Family planning and women’s lives in rural China. International Family Planning Perspectives. 30 (2): 68–76.
Jain, A. K. (1989. Fertility reduction and the quality of family planning services. Studies in Family Planning 20(1): 1–16.
Kaufman, J., Zhang, E. L. and Xie, Z. M. (2006). Quality of care in China: scaling up a pilot project into a national reform program. Studies in Family Planning 37 (1): 17–28.
Khan, H. R. and Shaw, J. E. (2011). Multilevel logistic regression analysis applied to binary contraceptive prevalence data. Journal of Data Science. 9, 93–110.
Li, J. M (2009). Fertility revolution in China. Population Research, 33(1): 1–9.
Liu, Y. R. (2004). Contraception use among married women in China. Chinese Journal of Family Planning. 5:260–262.
Magadi, M. A. and Curtis, S. L. (2003). Trends and determinants of contraceptive method choice in Kenya. Studies in Family Planning 34(3): 149–159.
Mason, K. O., Smith, H. L. (2000) Husbands’ versus wives’ fertility goals and contraceptive use: The influence of gender context in five Asian countries. Demography, 37: 299–312.
National Population and Family Planning Commission (NPFPC) edit. (2007). History of China Population and Family Planning. China Population Press: Beijing.
Philips, J. F., Simmons, R., Koening, M. A., and Chakraborty, J. (1988). Determinants of reproductive change in a traditional society: evidence from Matlab, Bangladesh. Studies in Family Planning. 19(6): 313–334.
Qin, M (2016). Evolution of family planning policy and its impact on population change in China. PhD thesis. University of Southampton, Social Sciences: Social Statistics & Demography.
Rasbash, J., Steele, F., Browne, W. and Goldstein, H. (2009). A user’s guide to MLwiN. Version 2, Centre for Multilevel Modelling, University of Bristol, UK.
Ross, J., Hardee, K., Mumford, E., and Eid, S. (2001). Contraceptive method choice in developing countries. International Family Planning Perspectives, 28(1): 32–40.
Ren, Q. and Zheng, X. Y. (2006). Behaviour change of Chinese married women on contraception use: 1988–2001. Chinese Journal of Population Science 3: 28–38.
Reng, N., Su, P., Guang, H. T., Wu, C. J., Zhou, J. L., Su, N., Liao, J. Y. and Xiong, C. L. 2003. Analysis on influencing factor for informed choice of family planning among rural women. Chinese Journal Public Health 19 (11): 1288–1289.
Seiber, E. E. Bertrand, J. T. and Sullivan, T. M. (2007). Changes in contraceptive method mix in developing countries. International Family Planning Perspectives. 33(3): 117–123.
Steele, F., Curtis, S. L. and Choe, M. K. (1999). The impact of family planning service provision on contraceptive use dynamics in Morocco, Studies in Family Planning, 30 (1): 28–42.
Stephenson, R. and Tsui, A. O. (2002). Contextual influences on reproductive health service use in Uttar Pradesh, India, Studies in Family Planning, 33(4): 309–320.
Tsui, A. O. and D. Bogue. (1978). Declining World Fertility: Trends, Causes and Implications. Population Bulletin, 33(4): 2–56.
The Johns Hopkins School of Public Health. (1989). Informed choice-. Report of the cooperating agencies task force. Baltimore, ML: Johns Hopkin Press.
Wang, C. (2012a). History of the Chinese Family Planning program: 1970–2010. Contraception, 85, 563–569.
Wang, C. (2012b). Trends in contraceptive use and determinants of choice in China: 1980–2010. Contraception, 85: 570–579.
World Health Organization (WHO). (2014). Ensuring human rights in the provision of contraceptive information and services Guidance and recommendations. WHO, Luxembourg.
Wu, J. Q. (2008). Counselling about informed choice of contraception. Chinese Journal of Family Planning 3:132–136.
Wu, S. C. (2008). Side effect of contraceptives and informed choice of contraception. Journal of Obstetrics and Gynecology. 24(3): 143–44.
Xie, Z. M. (2011) Focusing on quality of care in the Family Planning Programme. https://doi.org/ssc.undp.org/content/ssc/library/solutions/partners/gssdAcademy/Volume 19 Experiences_ in_Addressing_Population_and_Reproductive_Health_Challenges.html Accessed 28 February 2017.
Zhang, Y. Z. (2007). Factors influence contraceptive informed choice among rural women in Henan Province. Population Research, 31(4): 89–96.
Acknowledgement
This research is supported by ESRC (ES/J50016111). The authors thank the editors and anonymous reviewers, whose comments improved this artic1e a great deal.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
About this article
Cite this article
Qin, M., Padmadas, S.S. & Falkingham, J. Trends and Determinants of Contraceptive Method Choice in China. China popul. dev. stud. 1, 67–82 (2017). https://doi.org/10.1007/BF03500918
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03500918