Trend Of Contraceptive Use Among Married Women Of Childbearing Age In Shanghai:2004-2011

[Background]In general,a woman needs to use a contraceptive method for nearly 30-40 years during her life course to prevent unwanted pregnancy.The birth rate in Shanghai has been lower than death rate for more than 20 years.Thus,the time to use a contraceptive method for women in Shanghai may be longer.It is important to understand the contraceptive prevalence and its trend and to know women's choice of contraceptive methods so as to inform the policy-makers and family planning progremme managers.Shanghai Population and Family Planning Commission organized annual family planning surveys during last decade.There is a need to analyze the data in depth and to provide evidence for progremme and/or policy modification.[Objectives]To explore the decade-trend of overall contraceptive prevalence,the prevalence of any specific contraceptive method and the reasons of changes among married women of childbearing age with different characteristic.To provide recommendations for government to formulize family planning policy or intervention programme on the basis of this study.[Material and statistical methods]Data of this study are mainly from the annual family planning survey that was conducted between 2004 and 2011,which were organized by Shanghai Population and Family Planning Commission.Sample size was calculated at district level.Resident women aged between 15 and 49 were randomly sampled at each district by using "Shanghai Population and Family Planning Integrated Management System".The dataset of this study include more than 160 thousand women,approximately 20 thousand in each survey.Statistical analysis methods include weighting,stratified analysis,?2 test and multilevel multinomial Logistic regression.The expected contraceptive proportions were calculated using parameter estimates derived from the multilevel logistic regression.SPSS 16.0 and MLwiN2.25 were used for data analysis.[Results]The overall contraceptive prevalence among married women of childbearing age in Shanghai between 2004 and 2011 decreased from 89.50%in 2004 to 80.69%in 2011.The expected contraceptive prevalence ranges from 87.42%to 74.56%.The two contraceptive series follow a decline trend since 2006.IUDs and condom were the dominant methods.The prevalence of IUDs ranged from 65.68%to 42.17%,which followed a decline trend.The prevalence of condom ranged from 10.91%to 27.26%,following a increase trend.The prevalence of daily pills was low,ranging between 5.13%to 2.3%these years.Female sterilization adopted by 1.87%to 6.13%women,which was increased fast in recent three years.Few couples adopted male sterilization,accounting for less than 0.5%of participants.Prevalence of other contraceptives was low,ranging between 2.83%to 4.32%during 2004 and 2011.During the study period,contraceptive prevalence among women who had Shanghai Hukou declined faster than those who had Hukoui of other provinces.The prevalence increased with women's age except those who aged more than 44 years old.The prevalence of IUDs increased with women's age,but the prevalence of condom decreased with women's age.The better-educated women were more likely to use any contraceptive method and more likely to use condom,but less likely to use IUDs.Women who had an agriculture Hukou were more likely to adopt any contraceptive method as well as IUDs,but less likely to use condom than their non-agriculture counterparts.Women who had a Shanghai Hukou were less likely to use any contraceptive method.A woman from a higher income family was more likely to use condom than her counterpart.The proportion of women who did not use any contraceptive method due to childbearing related reasons has increased since 2006.Decline of contraceptive use among women below 30 years old appeared due mainly to increase of women who want a child.On the other hand,infertile(no need to use)was the main reason of not using any method among women who were aged 45 or above.Results of multilevel analysis indicate that the adotion of sterilization was associated with the survey year,woman's age,educational level,occupation,Hukou characteristics,local or migrant resident,household income,and the average population size of family planning service station,the second or higher birth rate,the educational and economic development at the district level.Determinants of IUDs include the survey year,the wife's age,education,occupation,Hukou characteristics,local or migrant resident,,household income,and the district economic and education status level.Determinants of condom use include the survey year,wife's age,education,occupation,Hukou characteristics,local or migrant resident status and household income.The survey year,the wife's age and household income were associated with adoption of daily pills.[Conclusions]Contraceptive prevalence in Shanghai declined in recent years.IUDs and condom were the dominant choices.However,the use of IUDs followed a decline-trend and the use of condom rose during last 8 years.The prevalence of daily pills was low.Owing to persistent increase of migrants,population structure in Shanghai is rapidly changing.Moreover,it appears that more couples wanted a child.The findings indicate that Shanghai may need to modify its family planning policy and develop new service programme in order to meet women's need on contraception.