Intention to have a second child, family support and actual fertility behavior in current China: An evolutionary perspective

Third birth intention of the working women with two existing children in Hainan Island, China: The impact of fertility costs and utility

This study evaluates the impact of fertility costs and utility on the third birth intentions among working women with two children in Hainan, China. A cross-sectional survey was conducted in Hainan Island, China in 2021 using an offline survey. Among 1067 working women with two children, only 8.06 % of participants reported having a third-birth intention. After adjustment for potential confounding factors, higher economic cost (odds ratio = 1.89) and lower succession utility (odds ratio = 5.08) were significantly associated with the lack of intention to have a third child. The analysis further demonstrates that family values significantly modulate these economic and utility considerations, highlighting a strong cultural influence on fertility decisions. This finding underscores the necessity for policies that not only mitigate financial burdens but also promote family values supportive of higher fertility. Such measures are essential for creating a cultural and economic environment conducive to higher birth rates.

Changes in fertility intention among married Chinese couples with two children during COVID-19: a cross-sectional study

BACKGROUND

A three-child policy was implemented in China to stimulate a rise in fertility levels and coincided with the COVID-19 pandemic. Data suggested that COVID-19 has a negative impact on fertility intention.

AIM

To describe married couples' changes in intention to have a third child during the COVID-19 pandemic and determine factors associated with altered intentions.

METHODS

An online survey was conducted in October 2021, including sociodemographic characteristics, change of intention to have a third child after the COVID-19 pandemic outbreak, reasons for increased or decreased intention, and the Fertility Intention Scale (FIS). Bivariate and multivariable logistic regression were used to test the potential factors associated with changes in intention.

RESULTS

A total of 1308 participants provided responses. Following the COVID-19 outbreak, 35.8% of participants decreased their third-child intention, while 2.8% of participants increased their third-child intention. Males (aOR 1.90, 95% CI 1.42 to 2.54), youngsters (aOR 1.77, 95% CI 1.08 to 2.93) and those living in Estern China (aOR 2.12, 95% CI 1.13 to 3.98) were more likely to decrease their third-child intention. Perceived risk (aOR 1.07, 95% CI 1.03 to 1.10) and policy support (aOR 1.06, 95% CI 1.03 to 1.09) as measured on the FIS decreased couples' intention to have a third child. Social support (aOR 0.94, 95% CI 0.91 to 0.98) as measured on the scale protected participants from decreased intention.

CONCLUSIONS

During severe public health emergencies, strong prevention and control policies, together with enhancing support from partners and healthcare professionals for women, are necessary to improve intentions to give birth.

Understanding the association between family planning and fertility reduction in Southeast Asia: a scoping review

OBJECTIVES

We aimed to explore and understand the extent and type of evidence on fertility reduction and its association with family planning (FP) in Southeast Asia.

DESIGN

Scoping review, following the methodological principles developed by Arksey and O'Malley and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines for reporting.

DATA SOURCE

We searched PubMed/MEDLINE, ProQuest, EBSCO, Scopus, Web of Science, Google Scholar and reference lists of relevant articles between 1 January 2012 and 31 December 2022. Only open-access articles in English were considered.

STUDY SELECTION

For inclusion, observational studies were selected for eligibility based on the original articles investigating the uptake of FP on women aged 15-49 years and its association with fertility decline in Southeast Asian (SEA) countries.

DATA EXTRACTION AND ANALYSIS

Two reviewers screened the records independently for eligibility and extracted all data. The specific details of the studies, including data on the authors, year of publication, setting, study design, aims/objectives of the study, specific intervention, outcomes and main findings, were reported.

RESULTS

We retrieved 615 articles and retained 12 articles included in the analysis. Of these, 11 were quantitative studies and 1 was qualitative study. The frequently reported strategy of FP was the use of contraception. FP not only allows women to control their birth by spacing and limiting their pregnancies but also delay their first childbirth by using contraceptive methods.

CONCLUSION

Our review suggests that the FP programmes aiming at reducing fertility should have a specific focus on improving the uptake and continuation of FP services.

Intention to have a third child among millennial parents with two children in eastern China: A cross-sectional survey

AIM

This Study Aimed to Assess the Intention to Have a Third Child among Millennial Parents (25-40 years old) with Two Children in a City in Eastern China and to Explore the Influencing Factors Related to Fertility Intention.

DESIGN

A cross-sectional design study.

METHODS

A convenience sampling method was used to enrol participants of childbearing age who visited two tertiary hospitals in Hang zhou, a city in eastern China, from June 2021 to March 2022. We conducted a face-to-face questionnaire survey with 520 participants and calculated the prevalence of intention-related factors. Multivariate logistic regression was used to analyse the independent influencing factors of fertility intention.

RESULTS

In total, 105 (20.2%) participants had the intention to have a third child. The results showed that 'employment status', 'age', 'reasons for wanting a third child', the considered 'biggest barrier to having a third child', 'views on the three-child policy', 'desired free services', 'supporting work policies' and 'assistance policies' were significant independent influencing factors of intention to have a third child (p-value < 0.05). The intention of the participants 'over 30 years old' was 2.466 times that of those '30 years old and under', and 'older age/personal health status' was considered the 'biggest barrier to having a third child'. Regarding policy and social reasons, the participants who need 'medical assistance' policy negatively affect the intention to have a third child (OR = 0.453, 95% CI = 0.247-0.830).

IMPLICATIONS FOR HEALTHCARE/NURSING

Nursing plays an important role in health promotion. Nurses can help couples make wise decisions about fertility by providing professional consultation, education, evaluation and support. They can also provide corresponding nursing and guidance to improve couples' health quality and overall reproductive success.

CONCLUSIONS

The general level of intention to have a third child of Millennial parents with two children is still low. The participants who are 'housewives/househusbands', 'over 30 years old', and satisfied with the state of 'medical assistance' have higher fertility intentions.

PATIENT OR PUBLIC CONTRIBUTION

It is particularly meaningful for the policymakers to improve the social support system and raise universal awareness to encourage childbirth.

The effect of gradually lifting the two-child policy on demographic changes in China

Low-fertility rate has been a common problem in many industrialized countries. To reverse the declining trend of new births, Chinese government gradually lifted its restrictions on the number of births per family, allowing for a household to have no more than two children. Little is known about the additional births or population increase contributed by the gradual relaxation of birth restrictions. To fill this gap, this quasi-experimental design study including data from 124 regions used the synthetic control method and controlled interrupted time series analysis to evaluate the differences in birth rates and rates of natural population increase between China and its synthetic control following implementation of the two-child policy from 2011 to 2020. A total of 123 regions were included in the control pool. Data collected during 1990-2010 were used to identify the synthetic China for each study outcome. The mean rate differences of birth rates and rates of natural increase between China and synthetic China after two-child policy implementation were 1.16 per 1000 population and 1.02 per 1000, respectively. These rate differences were distinguished from variation due to chance (one-sided pseudo-P-values: P for birth rates = 0.047, P for rates of natural increase = 0.020). However, there were statistically significant annual reductions in the pre-post trend of birth rates and rates of natural increase compared with those of controls of <0.340 per 1000 population per year [P = 0.007, 95% CI = (-0.584, -0.096)] and <0.274 per 1000 per year [P = 0.028, 95% CI = (-0.518, -0.031)]. The results suggested that lifting birth restrictions had a short-term effect on the increase in birth rates and rates of natural population increase. However, birth policy with lifting birth restrictions alone may not have sustained impact on population growth in the long run.

The mediating role of trust in government in intergenerational transmission of fertility intentions

China's one-child policy was in effect from 1982 to 2015. However, the literature examining the association between people's trust in local government and intergenerational transmission of fertility intentions is scarce. To fill this gap, we investigated the impact of individuals' sibship size on their ideal number of children, the mediating effect of their trust in local government on the issue of fertility between two successive generations, and the moderating effect of education level on sibship size related to trust in local governments. Based on the 2019 Chinese Social Survey data, 2,340 respondents aged 18-35 participated in the analysis. The results showed that (i) individuals' number of siblings significantly positively predicted their ideal number of children; (ii) individuals' number of siblings significantly negatively predicted their trust in the local government, which in turn significantly negatively influenced fertility intentions; (iii) the mediating mechanism was significant in residents with higher levels of education, but not in people with lower degrees of education. Fertility-boosting incentives can prioritize couples who are the only child in their family. It is necessary for local governments to improve their credibility and strengthen their pregnancy-related communication with groups with higher levels of education.

Factors associated with fertility intention among women with systemic lupus erythematosus in China: A cross-sectional study

OBJECTIVE

This study aims to explore the status and influencing factors of fertility intention in women of childbearing age with systemic lupus erythematosus (SLE).

METHODS

A total of 158 SLE patients admitted to the Affiliated Hospital of Nantong University from February 2021 to February 2022 were selected for a cross-sectional study. The dependent variable in this study was the fertility intention of lupus women of childbearing age, so the questionnaire was selected: "In view of your disease, do you plan to have children? Yes/no" as the measurement statement. Lupus patients were divided into fertility intention groups and non-fertility intention groups. The questionnaire survey comprises following scales: Hospital Anxiety and Depression Scale (HADS), Multidimensional Fatigue Inventory (MFI-20), Female Sexual Distress Scale-Revised (FSDS-R), and others. Independent t-test, one-way ANOVA, Mann-Whitney U test, and binary logistic regression were used for analysis.

RESULTS

The results showed that 20.9% of lupus patients in this study had a fertility intention. The fertility intention was associated with age, reproductive history, reproductive concerns, sexual distress, fatigue, family function, social support, depression, and sleep. Binary logistic regression showed that physical fatigue (OR 3.56, 95% CI 1.048-12.07) and personal health (OR 2.50, 95% CI 1.065-5.853) had significant predictors of fertility intention.

CONCLUSION

Our study identified a lower fertility intention in SLE patients who had reproductive concerns, sexual distress, family dysfunction, and fatigue. We encourage healthcare institutions to provide counseling services to all the SLE patients who have fertility intention and focus more on those who have requirements for fertility.

Revision and psychometric evaluation of a fertility intention scale for young women with breast cancer in Chinese Mainland

Objective

Neglected fertility intentions affect the quality of life of young women with breast cancer. The purpose of this study was to revise the Taiwanese version of the Fertility Intention Scale and validate its psychometric properties among young women with breast cancer in Chinese Mainland.

Methods

We performed a cross-sectional survey with young women with breast cancer at a Chinese cancer hospital to evaluate the psychometric properties of the Revised Fertility Intention Scale. A two-phase study was conducted: (1) revision of the scale and (2) evaluation of the scale's reliability and validity.

Results

Six new items and one new dimension were added to the original 15 items and four dimensions, reliability and validity of the 21-item Revised Fertility Intention Scale were verified in a sample of 436 women in Chineses Mainland with breast cancer who were aged 18-40 years. The content validity index, results of factor analysis, convergent validity, and known-groups validity were acceptable, and the Cronbach's alpha and intraclass correlation coefficients supported the revised scale.

Conclusions

The 21-item Revised Fertility Intention Scale has satisfactory reliability and validity for assessing fertility intentions among young women with breast cancer in Chinese Mainland. In clinical practice, nurses can use the scale to identify fertility intentions and associated factors in young women with breast cancer and develop feasible and effective oncofertility care measures.

Fertility Intention to Have a Third Child in China following the Three-Child Policy: A Cross-Sectional Study

China's three-child policy was implemented in May 2021 to stimulate a rise in fertility levels. However, few previous studies have explored fertility intentions to have a third child and have only focused on childless or one-child populations, resulting in a gap in findings between fertility intention and fertility behavior. Thus, we conducted a nationwide cross-sectional study on 1308 participants with two children. Results showed that only 9.6% of participants reported planning to have a third child and 80.2% of the population had heard of the policy but had no idea of the detailed contents. Participants with two daughters (OR = 3.722, 95% CI = 2.304-6.013) were willing to have one more child. Instrumental values (OR = 1.184, 95% CI = 1.108-1.265) and policy support (OR = 1.190, 95% CI = 1.124-1.259) were the facilitators. Perceived risk (OR = 0.883, 95% CI = 0.839-0.930) and higher educational level (OR = 0.693, 95% CI = 0.533-0.900) were the leading barriers to having one more child. Therefore, the government should deepen parents' understanding of the "three-child policy" and devise ways of reducing the negative impacts of having a third child to boost the intention to have more children. Our proposed approach can also be used to better understand the reasons for low fertility rates in other countries.

Social norms and fertility intentions: Evidence from China

China’s low fertility rates are a major concern across all sectors of society. Fertility is a major issue related to economy, society and family development. Based on social norms theory, this paper explores the influence of social norms on individuals’ fertility intentions from two perspectives: spatial proximity and social proximity. Using data from the China Family Panel Studies, we found that individual’s fertility intentions were influenced by social norms; both neighborhood social norms and group social norms had significant effects. The role of social norms in shaping individual fertility intentions varied by gender, hukou, and life course; specifically, men, rural residents, and married individuals were more significantly influenced by social norms. This study improves the theoretical framework of fertility decision making by arguing that in addition to macro and individual factors, social norms have a very important influence on fertility intentions. Our findings suggest that reshaping social norms regarding fertility is essential to enhance fertility rates in China.

The Impacts of the COVID-19 Pandemic on Fertility Intentions of Women with Childbearing Age in China

On 31 May 2021, the Political Bureau of the Central Committee of the Communist Party of China proposed the policy that a couple can have three children, and rolled out more supportive measures to further optimize the fertility policies. However, while the Chinese government is further optimizing its fertility policy, the sudden outbreak of COVID-19 is raging around the world, which threatens the implementation of China’s fertility optimization policy. Based on this, this paper firstly explores the impact of COVID-19 on women’s fertility intentions. Secondly, based on the Theory of Planned Behavior, this paper constructs a structural equation model to quantitatively reveal the specific factors that affect women’s fertility intentions under the epidemic, as well as their impact paths, and then puts forward corresponding suggestions for the government to solve the problem of fertility, aiming at delaying population aging and optimizing population structure. The research results show that: (1) COVID-19 lowers the fertility intentions of women of childbearing age. (2) During the pandemic, economic pressure emerged as the biggest factor affecting women’s fertility intentions. The decline in income caused by the pandemic has become an important factor in preventing women from having children. (3) The conflict between work and childbearing is still an important factor affecting the fertility intentions of women of childbearing age. The government’s provision of perfect childcare services and their strengthening of the protection of women’s employment rights and interests will greatly reduce women’s anxiety about childbearing.

Fertility Intentions for a Second Child and Their Influencing Factors in Contemporary China

Although the Chinese government has shifted from a one-child policy to a two-child policy (allowing a couple to have up to two children) since 2016 in response to the aging population, the policy results have been unsatisfactory. This is the first paper to systematically investigate the factors influencing residents' intentions to have a second child. The research focuses on the perspective of individual, family, and social characteristics based on the Chinese General Social Survey (CGSS) from 2017 to 2018. Three machine learning methods are used in conjunction with logistic regression to reveal that the intention of having a second child increases heavily with age, more siblings in the family of origin, and better health. The family income, which is currently the focus of the literature and is statistically significant, is only sixth most important. This study further reveals differences between genders: Women with a lower level of education and religious beliefs prefer to have a second child, whereas for men, non-agricultural hukou and marriage are the position factors. The results of this study also illustrate the importance of future research focusing on the relationship of individuals to their family of origin and districts.