Guangzhou is the capital city of Guangdong province, an economically developed province in south China. Tianhe district, where this study was conducted, was the pilot site where free PAC services were offered in public hospitals.
A cross-sectional survey was conducted in Tianhe district of Guangzhou during the period of June to September 2018. All those women who had experienced at least once IA in the selected public hospitals were included in the study. However, we excluded women who were unable to speak or listen and those with psychiatric disorder.
Sample size determination
The sample size was determined using the single population proportion assuming 57.4% of women utilizing PAC services and the desire to obtain reasonable estimates at 95% confidence level and 5% margin of error.
The total sample size was 431 women, taking into account 15% non-response.
Three public hospitals in Tianhe district that provided PAC services on a pilot basis were included in the study. The average number of PAC users was estimated according to the recent quarterly report of patients flow in each hospital. We used a systematic random sampling approach to select participants. The number of participants from each hospital was determined based on population proportion to size. Thus the number of participants was 156, 127 and 148 from the first, second and third hospital respectively.
Data were collected using an anonymous structured questionnaire. The development of the questionnaire was informed by existing literature on PAC utilization. The questionnaire was reviewed by experts in reproductive medicine and clinical epidemiology from China. After the pilot test, the questionnaire was revised accordingly, covering the following information: 1) socio-demographic characteristics, such as age, marital status, education, employment status, income and migrant characteristics; 2) reproductive history such as parity, previous IAs, number of living children; 3) contraceptive and reproductive health knowledge such as knowing how soon fertility returns and the time of getting pregnant again, uptake and method of contraception; 4) other related variables such as husband’/partner’ attitude on contraceptive use and person responsible for making contraceptive decisions
All participants were interviewed face-to-face after obtaining written permission. They were assured of the confidentiality of their identity and responses. The data collection phase was completed with the help of seven post-graduate female nurses. They were trained for two days by the principal investigator covering interview techniques, quality control, completeness of information and research ethics. All completed questionnaires were checked for completeness and consistency.
The primary data was entered into Epidata 3.1 before being exported to SPSS 20.0.
Women with missing information on key attributes were excluded from the analysis.
Categorical variables were presented as counts and proportions. Chi-square test was used to assess differences of socio-demographic characteristics, reproductive history, reproductive health knowledge and other related factors between abortion patients who used PAC services and those who did not. All factors with p value＜0.05 in the Chi-square analysis were included in the multivariable logistic regression to control confounding effect. Odds Ratio (ORs) with 95% confidence intervals (95% CIs) was calculated to measure the strength of association. A p value＜0.05 was considered statistically significant in the analysis.
The study protocol was approved by the Research Ethics Board of Southern Medical University, China. All participants provided written informed consent before being interviewed.