Socioeconomic, demographic, and behavioural determinants of modern conctraceptive non- use among sexually active Chinese university students

Abstract

Sexual and Reproductive Health (SRH) is a key developmental issue for adolescents and youth globally, including in China. Research has demonstrated that young people in China lack SRH knowledge and services to enable them to make informed decisions on contraceptive use. Non-use of modern contraceptives (MC) during sexual intercourse increases the risk of unintended pregnancies, Sexually Transmitted Diseases (STDs), and other harmful health consequences. This study focuses on university and college students in China. The aim of the study was to find socioeconomic, demographic and behavioural factors associated with the non-use of MC among Chinese university students. The secondary aim was to find the socioeconomic, demographic and behavioural factors associated with SRH knowledge among Chinese university students.

This is a quantitative study investigating 11,223 sexually-active university students from the National University Students Survey on Sexual and Reproductive Health (NUSS-SRH), a national-level survey on SRH among university students across China. NUSS-SRH was conducted by Tsinghua University in 2019-2020. The questionnaire was administered electronically through an online platform. The basic characteristics of the participants were tabulated. The stratified tabulation of basic characteristics was conducted by MC use during the most recent sex (MRS). The univariable logistic regression was then performed on selected socioeconomic, demographic and behavioural factors against MC use during MRS. Thirty-two significant socioeconomic, demographic and behavioural factors identified from the univariable logistic regressions were broadly categorized into individual level factors, inter-personal level factors and environment level factors according to the Social Ecological Model (SEM). These factors were progressively adjusted in 14 models. Lastly, the gender stratified logistic adjustment multivariable of MC use during MRS and SRH knowledge against socioeconomic, demographic and behavioural factors were conducted respectively. All analyses were performed in StataMP (Version 17).

The prevalence of MC non-use during MRS among surveyed sexually-active Chinese university students was 12.55%. The results show that at the individual level, being female, being younger in age, being a vocational school student, having smoking experience, having lower SRH knowledge, and not coming from a rich family were all associated with higher odds of MC non-use during MRS. At the inter-personal level, the findings show that being older at the first romantic relationship, being younger at the first sexual intercourse, not having a decision maker in MC use, and having experience of physical violence were all associated with higher odds of MC non-use during MRS. At the environment level, having difficulties accessing MC was found to be associated with MC non-use during MRS.

In the gender stratified analyses, being a vocational school student was associated with having lower SRH knowledge and higher odds of MC non-use among both male and female students. Having smoking experience was associated with having lower SRH knowledge among male students and higher odds of MC non-use behaviour among female students. Having no decision makers in the relationship for contraceptive use was associated with lower SRH knowledge among female students and higher odds of MC non-use behaviour among both male and female students. Increases in age were associated with greater SRH knowledge among both male and female students, but higher odds of MC non-use behaviour among male students. Being older at the first romantic relationship was associated with having greater SRH knowledge among female students while it was associated with higher odds of MC non-use among female students. Not coming from a rich family was associated with having more SRH knowledge among female students.

Benefitting from the large sample of data collected by the recent NUSS-SRH, the analyses in this study suggest that multiple determinants at various levels according to SEM are associated with MC use among Chinese university students. Gender disparities on the associations with MC use during MRS by these determinants were found. This study provides unique insights on developing programme interventions and relevant policies to promote MC use among university students, so that they could prevent unintended pregnancies and make informed decisions for their SRH.

Date of Award	15 Nov 2023
Original language	English
Awarding Institution	University of Bath
Supervisor	Emma Solomon-Moore (Supervisor) & Nick Townsend (Supervisor)