Analysis the contraception usage and unmet needs of education and reproductive health in Hubei province, China

background: In recent years, contraceptives have developed rapidly, which are divided into modern contraceptives and non-modern contraceptives. The use of contraceptives less unwanted pregnancy and sexually transmitted infections(STIs) including HIV. And cause traditional attitudes towards sex, marriage and family have changed. It leads to a lack of caution about sex and pre-marital sex is more acceptable. Hence, the number of miscarriages caused by unwanted pregnancies has increased. People is going to settle many of sexual and reproductive health matters. Methods: This study, was conducted of about 103 counties in Hubei Province from August 2014 to July 2016, which used frequencies, percentage, mean, chi-square, logistic regression to analysis this data that collected from 17555 respondents. (IBM-SPSS v 25.0) Results: The results in this article describe more men (62.6%) received family planning services education than women (37.4%). And people who did not participate in family planning services education, 17.0% and 21.9% did not know about vasectomy and withdrew as a method of male contraception, respectively. Striking, up to 23.9% and 22.8% of people with or without participating in family planning services education had experienced contraceptive failure (pregnancy for example) in couple. Age, educational, occupational status and the number of living children were strongly associated with contraceptive failure within participating in family planning services education. Only age, place of residence and number of living children were signicant associated with contraceptive failure without participating in family planning services education. The gure showed greatly unmet needs of education and reproductive health whether or not to accept family planning services education Conclusion: There is a huge difference in Knowledge and use of contraceptives, as well as unmet educational and reproductive health needs between those who participated in family planning services education and those who did not. That means people who participate in family planning services education got more about sexual and reproductive health education and understand the important of the family planning services. Therefore, it is to family planning services more people and regions to obtain a good understanding of contraceptives, sexual intercourse and unintended pregnancy. The results in this article describe up to 23.9% and 22.8% of people with or without participating in family planning services education had experienced contraceptive failure (pregnancy for example) in couple. Age, educational, occupational status and the number of living children were strongly associated with contraceptive failure within participating in family planning services education. Only age, place of residence and number of living children were signicant associated with contraceptive failure without participating in family planning services education. The gure showed greatly unmet needs of education and reproductive health whether or not to accept family planning services education In conclusion: People who participate in family planning services education got more about sexual and reproductive health education and understand the important of the family planning services. Therefore, it is necessary to provide family planning services for more people and regions to obtain a good understanding of contraceptives, sexual intercourse and unintended pregnancy.


Introduction
The one-child policy has been in effect since 1980, family planning services mainly restricted to IUD and sterilization (tubal ligation) to control the population in china [1]. Indeed, family planning services settled many of sexual and reproductive health matters. Some studies show that early sex and subsequent unsafe behavior can increase the risk of STIs [6][7][8]. And the World Health Organization (WHO) also estimated that roughly 1 million people are infected with any of four curable sexually transmitted infections every day(including chlamydia, gonorrhea, syphilis, and trichomoniasis) [9]. However, in recent decades, contraceptives have developed rapidly, which are divided into modern contraceptives (including Sterilization, Intrauterine devices, Oral contraceptives, Emergency contraceptive pills, etc.) and nonmodern contraceptives (including Withdrawal, Lactational amenorrhea Abstinence etc.) [2]. Contraceptive methods are aimed to overcome biological advances in technology that allow couples to have sex whenever they want and most important is to protect the health of mother and child. Moreover, the use of contraceptives is not only less unwanted pregnancy and less STIs including HIV, but is also to improve family income and the status of women [3][4][5]. We believe that the people who are in the reproductive age need a good understanding of sexual intercourse and unintended pregnancy. Similarly it is also necessary to strengthen education on sexual and reproductive health.
With the development of economy and the popularization of internet and social media, young people are becoming more open-minded in China [10]. And cause traditional attitudes towards sex, marriage and family have changed [11]. It leads to a lack of caution about sex and pre-marital sex is more acceptable [12]. Hence, the number of miscarriages caused by unwanted pregnancies has increased. According to the latest available gures, 13 million induced abortions were conducted in China in 2008 [13]. Furthermore, unmarried women accounted for 30%-35% of all induced abortions in china [15][16][17] and it is also estimate that there were 35 abortions per 1000 women aged 15-44 years worldwide each year and some 25% of pregnancies ended in abortion in globally in 2010-14 [14]. However, the number would be even higher than it is now if not using use contraceptives. Thus, Knowledge of contraceptives and the choice of effective contraceptives are greatly important.
China introduced the universal two-child policy in 2015. Family planning services also play an important role in new policy cause people who have undergone ligation maybe want to get second baby. Then it can provide counseling of restoring fertility and technical services for them. The same family planning service can also provide the knowledge of pre and postnatal care, sexual health matters, parenting rights and regular reproductive health examination. Because people's knowledge of contraceptives and how to choose suitable contraceptives is still relatively weak. This study is focused on to the knowledge, behavior and use of contraceptives and unmet needs of family planning services among people of reproductive age with or without accepted family planning services education in Hubei province, China.

Study Population
A cross-sectional study was conducted of about 102 counties in Hubei Province from August 2014 to July 2016. 17555 respondents aged 18-49 (female) and 20-60 (male) lled the questionnaire, which have lived in the area for at least six months and provide informed consent. Five towns (streets) were selected from each county in Hubei Province, and two village (resident) groups were selected from each township: a total of 20 sample points were selected from each village (resident) group, and the sample size was determined according to the number of people in each township. Fourteen investigators ( ve peer educators from local communities, ve medical staff from health districts and four junior researchers from the Hubei Provincial Family Planning Institute) were interviewed in different regions. The survey investigators had to summarize and provide sexual and reproductive health education including family planning counseling each time to respondents

Statistical analyses
This study was to analysis knowledge and use of contraceptives and unmet needs of education and reproductive health, as well as the factors of failure of contraception among with or without accepting family planning services education by frequencies, percentage, mean, chi-square, logistic regression. The data collected were from a 37-question questionnaire lled out by 17555 people. Statistical analysis was performed using IBM-SPSS v 25.0 Ethical consideration Ethics approval was provided by the Hubei Family Planning and Reproductive Institute of Tongji Medical College and eld authorizations were delivered by the local authorities. During the data collection training phase, the researchers obtained the informed consent of all participants. This information provided by the participants only be used for scienti c research and we kept it con dential 3 Result

Sociodemographic Characteristics of Respondents
A total of 17555 people lled in the questionnaire, of whom13382 (76.2%) were participating in family planning services education and 4173 (23.8%) were not. Most of the study participants belonged to the Han ethnic group. In addition to, more men (62.6%) had received family planning services education than women (37.4%). There was no signi cant difference in educational attainment between those who attended family planning services education and those who did not. In terms of educational experience, almost all those who received family planning service education (95.4%) and those who did not (93.7%) had a junior high school diploma or above. The majority of those who take part in family planning services education (56.1%) and those who did not (49.8%) come from countryside. As far as work is concerned most of the people who either participate in family planning services education or who did not participate in family planning services education had jobs. (Table 1).

Knowledge About Male Contraceptives
The majority (77.2%) of all respondents participated in family planning services education and those (67.6%) who did not participate in family planning services education knew about condom as a contraceptive method. Only a small percentage (5.5% and 15.0% )of those who participate in family planning services education are unaware of vasectomy or withdrawal as a method of male contraception whereas, among those who did not participate in family planning services education, 17.0% and 21.9% of all people did not know about vasectomy and withdrew as a method of male contraception, respectively.
More than half of the respondents who with (65.9%) or without (57.1%) participating in family planning services education think condom was the best contraceptive method. Yet up to 22.5% of people who did not participate in family planning services education did not know the best method of male contraception. (Table 2) N refers to total number of respondents; % refers to percentage; p refers to the p-value at p ≤ 0.05 About the knowledge of the characteristics of male contraceptives, approximately two-thirds of the respondents who take part in family planning services education (77.2%) and those who did not (67.7%) think safe and effective should be the characteristics of male contraceptives. Regarding Less harmful to body and Operation should be simple, about half of the respondents who accepted family planning services education (62.8%;54.6%) and those who did not (58.8%;46.9%) think that also should be the characteristics of male contraceptives. However, still 11.4% of people who did not participate in family planning services education have no opinion for the characteristics of male contraceptives compared with those (5.8%) who participated in family planning services education. Additional, a part of the people who participate in family planning services education (25.7%) and those who did not (20.7%) indicated that vasectomy affects physical labor whereas both of them(24.4% with or 20.5% without participating in family planning services education) also revealed that side effects and complication is the most severe disadvantage of vasectomy. Moreover, up to 25.8% of people who did not participate in family planning education didn't know the most severe disadvantage of vasectomy compared with those (16.3%) who participated in family planning services education (Table 3) N refers to total number of respondents; % refers to percentage; p refers to the p-value at p ≤ 0.05 According to Table 2 and Table 3 showed a signi cant difference in knowledge of male contraceptive between those who received family planning services education and those who did not.

The Types Of Contraception Method Currently Used
About 69.8% and 64.8% of the respondents among with or without received family planning services education reported that they currently use female contraceptives. Whereas, there was an obvious difference between taking in family planning services education and did not taking in family planning services education in not using contraception, respectively 11.6% and 16.7%. Additional respondents who were not using contraception, more than one third (36.8%; 37.7%) have no interest in contraception among with or without accepted in family planning services education. Some of people who participated in family planning services education (25.0%) and those who did not (28.5%) were in the pregnancy period.

Factors Of Failure Of Contraception
Despite there was no difference between participating in family planning services education and nonparticipating in family planning services education even in contraceptive failure, but yet up to 23.9% and 22.8% of people with or without accepting in family planning services education had experienced contraceptive failure (pregnancy for example) in couple (Table4).   Variables Participating in family planning services Not participating in family planning services education (contraceptive failure) education (contraceptive failure) OR (95% CI) p-value OR (95% CI) p-value AOR refers to Adjusted Odd Ratio; CI refers Con dence Interval and p refers to the p-value at p ≤ 0.05.

Education And Reproductive Health Unmet Needs
According to Table 6 there shows a huge difference in the education and reproductive health unmet needs between accepting in family planning services education and did not. But refer to education about pre and postnatal care, contraceptive methods, sexual health matters, sexually transmitted diseases(STDs) and prevention, parenting rights Showed greatly unmet needs Whether or not to accept family planning services education. Similarly involved reproductive health about free premarital health and regular reproductive health examination, Guidance of healthy pregnancy and access and technical services of contraceptives for free also Showed greatly unmet needs Whether or not to accept family planning services education  [18,19]. However, In 1979 china had begun most strictly implement the one-child policy which controlled population growth in order to economic growth [20] and intended to protect both the health of mothers and children. Furthermore, family planning services provided free contraceptives to protect women's reproductive health from sexually transmitted infections. More recently, the number of married women who either use contraception or who have an unmet need for family planning is projected to grow from 900 million in 2010 to 962 million in 2015 and will increase in most developing countries [21] Here the ndings revealed that most of the respondents knew about the knowledge of male contraceptives. But those who accepted education about family planning services knew more about the knowledge of male contraceptives (including ways, advantages, disadvantages) than those who did not.
( Although male contraceptive using so simple, about 69.8% and 64.8% of the respondents among with or without received family planning services education reported that they currently using female contraceptives far more than using male contraception (Table 4). Our data are in line with many previous studies: women dominated in family planning [22][23][24][25]. Furthermore, Ventura et al reported 89% of reproductive aged women are currently using some form of contraception [26] Strikingly, respondents who were not using contraception, more than one of third (36.8%;37.7%) have no interest for contraception among with or without accepted in family planning services education. It may be because someone does not want to use contraceptives that the number of unwanted pregnancies and abortion increases [2]. People need to be educated about the dangers of abortion through family planning services.
Yet up to 23.9% and 22.8% of people with or without accepting in family planning services education had experienced contraceptive failure in couple (Table4). The failure rates are higher than other studies. Such as other studies indicate that the most effective methods of contraception include Long Acting Reversible Contraceptive(LARC) methods and sterilization which have a failure rate less than 1% (27,28). Pills, the transdermal patch, injectables, and the vaginal ring also have effective when used correctly but the failure rate up to 7% when user error (29)(30)(31)(32)(33). Similar with combined methods, condom e cacy is limited and the failure rates approach 13% (34,35). Table 5 shows reported ages, education, occupational status and having no living children had a signi cant effect on contraceptive failure within participating in family planning services education. while only age, place of residence, occupational status had an effected on contraceptive failure without participating in family planning services education. Different age, educational, occupation affected the understanding and choice of contraceptives. We also found that a greatly unmet needs of the education and reproductive health whether or not to accept family planning services education. In 2010,146 million (130-166 million) women worldwide aged 15-49 years who were married or in a union had an unmet need for family planning [21]. It should be noted that several studies suggested that have a huge unmet need of education and reproductive health [36][37][38][39][40] Conclusions This study revealed that there is a huge difference in Knowledge and use of contraceptives, as well as unmet educational and reproductive health needs between those who participate in family planning services education and those who did not. That means people who participate in family planning services education got more about sexual and reproductive health education and understand the important of the family planning services. Therefore, it is necessary to provide family planning services for more people and regions to obtain a good understanding of contraceptives, sexual intercourse and unintended pregnancy Limitation Availability of data and materials The datasets during and/or analysed during the current study available from the corresponding author on reasonable request.

Competing of interest
There are no con icts of interest