Objectives: To determine the prevalence of stress and depression and associated factors among women seeking a first-trimester induced abortion in China. Methods: A cross-sectional study was conducted in a tertiary hospital in Beijing, from April 1st to Oct 31st, 2021. Women seeking termination of an intrauterine first-trimester pregnancy were invited to participate and complete a digital self-administered questionnaire. The survey included socio-demographic and health questions, Perceived Stress Scale-10 (PSS-10), and Patient Health Questionnaire-9 (PHQ-9). Descriptive analyses and binary logistic regression analyses were performed using SPSS 23.0. Results: A total of 253 women participated. Prevalence of high perceived stress (cut-off ≥ 20) and depressive symptoms (cut-off ≥ 10) was 25.3% and 22.5%, respectively. Women were more likely to suffer high stress if they reported low resilience (aOR = 16.84, 95% CI 5.18–54.79), were not-using contraceptives (aOR = 3.27, 95% CI 1.39–6.29), had low social support (aOR = 2.95, 95% CI 1.39–6.29), were non-local residents (aOR = 2.51, 95% CI 1.15–5.92), were dissatisfied with their intimate relationship (aOR = 2.44, 95% CI 1.15–5.16), or held pro-life attitudes towards abortion (aOR = 1.04, 95% CI 1.18–3.53). Odds of experiencing depression were higher among women who also reported high perceived stress (aOR = 19.00, 95% CI 7.67–47.09), had completed higher education (aOR = 12.28, 95% CI 1.24–121.20), and were non-local residents (aOR = 3.38, 95% CI 1.37–8.32). Conclusions: The magnitude of perceived stress and depression was high among Chinese women seeking a first-trimester induced abortion. It is necessary to comprehensively evaluate the mental health of women seeking an abortion, especially those with high risk. Interventions to mitigate relevant associated factors could improve the psychological wellbeing of women.

Accessing good quality abortion care is a fundamental human right and contributes to achieving Sustainable Development Goals. However, well-designed abortion care that meets women’s needs is limited. This study aims to systematically develop an intervention to promote the psychological well-being of Chinese women undergoing an abortion. A five-step iterative approach informed by intervention mapping was undertaken to determine the intervention design. Step 1 used in-depth interviews with 14 Chinese women undergoing an abortion to assess real-life stressors and support needs. We identified eight stressors and found women’s support needs varied with the time trajectory of the abortion. Step 2 used a focus group discussion with care providers to select modifiable stressors that impact negative psychological outcomes. In Step 3 and Step 4, we determined and integrated the exact strategies to eliminate or mitigate possible modifiable stressors by incorporating information from in-depth interviews and the Transactional Model of Stress and Coping. The integrated strategies were instructional support, informational support, and timely communication. In Step 5, we composed the detailed intervention design according to the best available evidence and, to confirm content validity, consulted 10 women who had undergone abortion in the previous 2–6 weeks. The intervention was titled STress-And-coping suppoRT (START), which included four interacting components: (1) a face-to-face consultation at the first appointment; (2) a printed booklet with information on abortion, self-care, and managing emotions and intimate relationships; (3) a WeChat-based online public profile page offering the same information as the booklet; (4) a telephone hotline. This study paves the way for a new approach to addressing the psychological needs of women experiencing abortion in China. The rigorous process provides an example of developing tailored health promotion interventions.

Preterm birth is a leading cause of neonatal and child mortality and morbidity worldwide. The aim of this study was to investigate associations between attending a brief antenatal lifestyle education seminar and preterm birth, and whether education timing modifies outcomes. A retrospective cohort study was conducted in a hospital-based antenatal care center in Beijing, China, where a free, 2 h, optional, face-to-face, midwife-led group seminar on healthy lifestyle choices during pregnancy was provided. Among the 3008 eligible women, 1107 (36.8%) attended the seminar during the first trimester, 515 (17.1%) attended during the second trimester or later, and 1386 (46.1%) did not attend. Multiparous women were more likely to not attend or to attend at a later stage. The overall prevalence of preterm birth was 8.7%, but it was higher for women who did not attend the antenatal seminar (11.5%). The risk of preterm birth for first trimester attendees decreased by 53%, and it decreased by 41% for later attendees. Estimates persisted after adjusting pre-existing and gestational covariates. Attending a brief antenatal lifestyle education seminar was associated with lower preterm birth risk, and attending during the first trimester had a better impact than later attendance. The results can inform the development of tailored preterm birth prevention strategies.