2.1. Study design and participants
The current study was a secondary analysis of data from the Women Health Needs Survey. The original study was a cross-sectional study conducted by the Women's Federation, Office of the Committee for Women and Children's Workers, and Health Administration in Hunan Province, where located in middle China. It collected data from five representative and distinct areas in Hunan Province between April 1 and August 20, 2018, to understand the women's most common health problems and health care needs at different ages from 10 to 70 years old.
The details of data collection have been reported elsewhere [27-29]. Data collection used four types of questionnaires in four age groups (10-19 years, 20-39 years, 40-49 years, and 50-70 years), which had undergone extensive literature research and were evaluated by an expert panel comprised of 10 experts from Central South University, an affiliated hospital, and the Hunan Province Women's Federation. The inclusion criteria included women aged 10-70 years who lived in Hunan Province and could understand and speak Chinese, and excluded women with mental illnesses or those who could not communicate with others. In addition, all investigators were well trained. In this study, we selected women of childbearing age from 20 to 49 years old.
2.2 Measurement and variables
2.2.1 Definition
In the current study, the women who answered "yes" to the question "Were you recommended contraception after induced abortion by service providers?" were defined as received FPAPS. The PAFPS prevalence was the percentage of women who received PAFPS among women with an IAs history.
Women were asked whether contraception at present and the use of contraceptive methods allowed them to choose more than one method. Contraceptive methods were outcome variables, which we classified as reliable and unreliable. According to the guidelines and experts' consensus [13, 19], reliable contraceptive methods consisted of male and female sterilization, IUD, implantation, oral contraceptive pills, and condoms. Un-reliance included emergency contraception, contraceptive ointment/film, withdrawal, periodic abstinence, and external spermicide. As long as any reliable method was used, she was classified as using reliable contraception. Otherwise, it was unreliable contraception.
2.2.2 Social demographic characteristics
Social demographic characteristics consisted of age, occupation, educational level, marital status, personal monthly income, family monthly income, and the number of children. Marital status was classified as married (including married, remarried, and cohabitation) and single (including single, separated, divorced, or widowed). We ranked educational levels as low, middle, and high. Low means had received 0-9 years of education, middle means 10-12 years of education, and high means more than 12 years of education. When asked about family income and personal income, our unit is RMB (¥, 1¥≈ 0.1546$, 7/16/2021).
2.2.3 The experience of IAs and PAFPS
The IA experience included IAs history, methods, and satisfaction with the last IA. Painless surgical abortion methods meant surgical abortion with general anesthesia, and non-painless methods meant no anesthesia.
The PAFPS experience included five questions. The question "What contraceptive methods did the service providers tell you about?" was multiple-choice, which were classified as reliable and unreliable methods. The question "Do you know the harms of abortion?" was comprised of 8 items. It was also multiple choice. "No harm," "Do not know," "Not clear," was scored as zero, and "Dysmenorrhea," "Infertility," "Genital tract infection," "Uterine leiomyoma," "Others," was scored as one. Finally, we calculated the final scores. Other questions were "Have you been followed up after the last induced abortion? ", "How did the service providers introduce contraceptive methods to you? ", "Were you informed about the side effects of the contraceptive methods? ".
2.2.4 The desired way to get relevant knowledge
Participants were asked where they wanted to obtain relevant knowledge about contraception, and whether they could choose one or more options.
2.4 Statistical analysis
Data entry was carried out in Epi-Data version 3.0, and the Statistical Package for Social Sciences (SPSS) v26.0 (IBM, Chicago, IL) was used for the statistical analysis. Categorical variables were analyzed by descriptive statistics, including frequencies and percentages. The chi-square test compared the differences between reliable and unreliable contraceptive methods, the reported P values were two-sided, and a value of P<0.05 defined statistical significance. We adjusted the significant variables and all variables with binary logistic regression analysis to identify the relevant factors related to contraceptive method use after receiving PAFPS through odds ratios (ORs) and 95% confidence intervals (CIs).