Unpacking the complexity of contraceptive use among Chinese university students 2014-2024: a systematic review and...

High risks of unintended pregnancies and abortion have been reported among Chinese university students; however, their contraceptive use remains poorly understood. This study synthesised Chinese university students' contraceptive usage to inform the development of context-specific contraceptive investigations and interventions. We searched six databases from 1 January 2014 to 31 December 2024. Studies with clear definitions and comprehensive data reporting the usage of any contraceptive among Chinese university students either in China or attending universities abroad were included. Eligible studies were independently appraised by two authors. Random-effects meta-analyses were used to estimate pooled proportions of any contraceptive use. Of 6476 records identified, 34 studies were included. The proportions of any contraceptive use were reported across three important dimensions, namely, frequency of use, duration of use and at a specific time point (first/last sex). Accordingly, using any contraceptive, using any contraceptive every time and using any contraceptive at first sex among sexually experienced Chinese university students were commonly reported measurements, with pooled proportions of 74.5% (95% confidence interval (CI): 55.0-87.4%, I2 = 98.6%), 43.4% (95% CI: 33.6-53.8%, I2 = 97.5%) and 60.8% (95% CI: 51.4-69.4%, I2 = 96.8%), respectively. Subgroup analyses were performed; however, careful interpretation is required given the wide CIs, significant and unexplained heterogeneity, and the risk of bias. Findings revealed varied measurements of any contraceptive use substantiate the methodological challenges in assessing contraceptive behaviour among university populations. Future studies should adopt transparent, standardised and contextually justified measurement approaches in both global and local contexts.