Factors affecting contraceptive use among women seeking induced abortion in Hubei, China: a multicenter cross-sectional study

Yun Tao^1,2,3Chun Feng⁴Youling Zeng⁵Yujuan Li^1,2,3Xin Du⁴Ling Zhang⁶Dan Li⁷Wenhua Zhang⁸Jiawei Kang^1,2,3Juan Liu^1,2,3Yuan Lu⁷Xia Sun⁷Yuanzhen Zhang^1,2,3*

• ¹Department of Obstetrics, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
• ²Hubei Clinical Research Center for Prenatal Diagnosis and Birth Health, Wuhan, Hubei, China
• ³Wuhan Clinical Research Center for Reproductive Science and Birth Health, Wuhan, Hubei, China
• ⁴Department of Gynecology, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei, China
• ⁵Department of Gynecology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College Huazhong University of Science &Technology, Wuhan, Hubei, China
• ⁶Huanggang Maternal and Child Healthcare Hospital, Huanggang, Hubei, China
• ⁷Wuchang Maternal and Child Healthcare Hospital, Wuhan, Hubei, China
• ⁸Department of Obstetrics, Huangmei People's Hospital, Huanggang, Hubei, China

Background: Contraception plays a vital role in improving maternal and neonatal health by preventing unintended pregnancies. This study aimed to assess the history of contraceptive use and identify factors influencing contraceptive behavior among women seeking induced abortion in central China. Methods: A multicenter cross-sectional study was conducted in 25 hospitals across Hubei province. Data were collected using a structured questionnaire, and multivariable logistic regression was applied to evaluate factors associated with frequent contraceptive use. Results: Among 2,099 participants, only 53.1% reported frequent contraceptive use in the year prior to the current pregnancy. Frequent use was positively associated with higher education (postgraduate or above: OR=4.81, 95% CI: 1.85 – 12.48), higher household income (>10,000 yuan/month: OR=1.97, 95% CI: 1.38 – 2.82), longer interval since last abortion (≥12 months: OR=2.07, 95% CI: 1.33–3.23), no history of abortion (OR=2.35, 95% CI: 1.37–4.01), positive attitudes toward contraception (OR=1.61, 95% CI: 1.32 – 1.96), and male-dominant decision-making in the household (OR=1.45, 95% CI: 1.08–1.94). Only 2.3% of participants reported using long-acting reversible contraception. The findings align with the Theory of Planned Behavior, highlighting the roles of individual attitudes, subjective norms, and perceived behavioral control in shaping contraceptive practices. Conclusion: Contraceptive use among women seeking induced abortion remains suboptimal. Interventions should target improving attitudes toward contraception, engaging male partners, addressing socioeconomic barriers, and expanding access to diverse contraceptive options, especially for women with recent abortion history. These measures may help reduce unintended pregnancies and repeat abortions.