Background Pregnancies have been increasing since the universal two-child policy in China was announced and thus the prevention of short inter-pregnancy intervals has become more important. However, little is known about contraceptive use among postpartum women in rural areas of China. This study investigated the current situation and factors associated with contraceptive use, especially long-acting reversible contraception (LARC) practice among postpartum women.

Study design A cross-sectional study was conducted with a probability proportionate to size (PPS) sampling method in Shimen County of Hunan province with 423 mothers whose youngest child was aged under 2 years. A questionnaire was used to collect information on participants’ demographics, reproductive history and contraceptive use.

Results The rate of using all contraceptive methods was 66.4% in the study group and the rate of using LARC was 9.9%. Statistically significant predictors of contraceptive use were: no breastfeeding, no intention of having another child, and education beyond high school. Statistically significant predictors of LARC utilisation were: vaginal delivery, at least one child before the index delivery, and no breastfeeding.

Conclusions The utilisation rate of postpartum contraception, especially LARC, was relatively low in rural China. The benefits of LARC have not been realised and breastfeeding is still incorrectly believed to be a definitely reliable method of contraception. Thus, health education and contraceptive knowledge and regulations need to be updated and enhanced based on research evidence, for increased adoption of postpartum contraception in rural China.