East Asian childbearing patterns and policy developments

Diverse pathways to permanent childlessness in Singapore: A latent class analysis

The proportions of adults reaching midlife without having children have been rising rapidly across the globe, particularly in Asia. However, little is known about the pathways to permanent childlessness within the region's childless population. This study utilized latent class analysis (LCA) to typologize pathways to childlessness based on dynamic characteristics of multiple life domains (i.e., partnership, education, and occupation) among 489 childless Singaporeans aged 50 and above from a 2022 nationwide survey. Additionally, we utilized multinomial logistic regressions to examine the sociodemographic correlates of pathway profiles and Shannon's entropy index to assess the heterogeneity in pathways to childlessness among successive cohorts. Results revealed five distinct profiles of pathways to childlessness: the Never-Married Semi-Professionals, the Low-Flex Blue-Collars, the Highly Educated Professionals, the Ever-Married Semi-Professionals, and the Flexible Blue-Collars. These pathway profiles were significantly associated with sociodemographic characteristics such as gender and family background. Women's pathways to childlessness were more standardized and heavily influenced by partnership characteristics, compared to those of men. The childless from privileged family background were less likely to follow pathways characterized by disadvantageous education and occupational status. There were also rising trends of voluntary childlessness among married childless individuals and increasing heterogeneity in pathways to childlessness across successive birth cohorts. In sum, our findings are consistent with some of the predictions of the Second Demographic Transition theory, suggesting that Singapore may be experiencing a demographic transition characterized by rising childlessness, decoupling of marriage and childbearing, and de-standardization of the life course.

Defining and Identifying Only Children: A Research Note on the Concept and Measurement Illustrated With UK Survey Data

Despite increasing interest in the circumstances and outcomes of only children in the demographic literature, the conceptualization of this group has received limited scholarly attention. This research note argues for greater engagement by demographers and social scientists in the conceptualization and identification of only children by addressing three aims. First, we outline potential definitions of only children, present a framework to guide researchers' decisions, and evaluate whether only children can be reliably identified using the British birth cohort studies. Second, we show that the prevalence estimates are contingent on the timing of measurement in childhood, indicating the need for caution when deriving only-child status from cross-sectional household grid data. Third, we demonstrate that both the size and the characteristics of the only-child group may differ across definitions, highlighting that the accurate operationalization of some definitions is particularly restricted by survey designs that prioritize mothers for data collection on children and families. We argue that researchers interested in sole children's outcomes must choose the most appropriate measure for a given research question and, given that many datasets limit how accurately any indicator of only children can capture the chosen definition, reflect on how the operationalization of their measure might affect the results.

Assisted reproductive technology in Japan: A summary report for 2021 by the Ethics Committee of the Japan Society of Obstetrics and Gynecology

Purpose

The Japan Society of Obstetrics and Gynecology (JSOG) registry gathers comprehensive data from registered assisted reproductive technology (ART) facilities in Japan. Herein, we report 2021 ART cycle characteristics and outcomes.

Methods

Descriptive statistics were used to summarize and analyze 2021 data.

Results

In 2021, 625 ART facilities participated in the registry; 27 facilities did not conduct ART cycles and 598 registered treatment cycles. In total, 498 140 cycles were registered, and there were 69 797 neonates (increases of 10.7% and 15.5%, respectively, from the previous year). The number of freeze-all in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles decreased in 2021; the number of neonates born was 2268 for IVF-embryo transfer (ET) cycles and 2850 for ICSI cycles. Frozen-thawed ET (FET) cycles increased markedly from 2020 (11.2% increase). In 2021, 239 428 FET cycles were conducted, resulting in 87 174 pregnancies and 64 679 neonates. For fresh transfers, the total single ET, singleton pregnancy rate, and singleton live birth rates were 82.7%, 97.0%, and 97.3%; for FET, these rates were 84.9%, 96.9%, and 97.1%.

Conclusions

The 2021 Japanese ART registry analysis showed marked increases in both total treatment cycles and live births from the previous year.

Low fertility and fertility policies in the Asia-Pacific region

Declining fertility is an increasing global trend. In many low fertility contexts, people are having fewer children then they want, and these unfulfilled fertility desires have been associated with wider socio-economic changes in education and labour force participation and conflicting and often contradictory expectations of women at home and at work. The right to determine if, when and how one has children is enshrined in international law yet many policies responses to low fertility fail to meet these standards. This paper summarizes why people in the Asia-Pacific region are having fewer children than they desire, and the range of policy responses, particularly those that make life easier for working parents. This raises two important points. First, we need to contend to the gender dynamics that underpin this in the region, despite gradual changes in women's roles, they are still seen as "caregivers" and undertake a disproportionate amount of unpaid care work, often having to lean-out of their employment, and/or face gender discrimination in the workplace. Second, the "emergency" of low fertility arises from complex social and economic conditions that cannot be solved by population policies solely focused on making babies.

Rising trend of childlessness in China: analysis of social and regional disparities with 2010 and 2020 census data

INTRODUCTION

In recent decades, there has been a significant increase in childlessness. This paper analysed childlessness in China, specifically examining its socio and regional disparities.

METHODS

With data from China's 2020 population census, supplemented with data from China's 2010 population census and 2015 inter-censual 1% population sample survey, we used a basic indicator of age-specific childlessness proportion, a decomposition method, and probability distribution models to analyse, fit and project childlessness.

RESULTS

We presented age-specific childlessness proportions for women as a whole and by socioeconomic features, decomposition and projection results. The childlessness proportion increased markedly from 2010 to 2020, reaching 5.16% for women aged 49. The proportion is highest for city women, followed by township women, and is lowest among village women, at 6.29%, 5.50% and 3.72 % for women aged 49, respectively. The proportion for women aged 49 with high college education or above was 7.98%, and only 4.42% for women with junior high school education. The proportion also exhibits marked provincial discrepancies, and the total fertility rate is negatively correlated with childlessness at the province level. The decomposition results distinguished the different contribution of change in educational structure and change in childlessness proportion for subgroups to the total childlessness proportion change. It is projected that city women, women with high education will have higher childlessness proportion, and the proportion will further increase with the rapid increase in education level and urbanisation.

CONCLUSIONS

Childlessness has risen to a relatively high level, and varies among women with different characteristics. This should be taken into consideration in China's countermeasures to reduce childlessness and curtail further fertility decline accordingly.

Cross-sectional average length of life by parity: Country comparisons

This study aims to present an alternative measure of fertility-cross-sectional average length of life by parity (CALP)-which: (1) is a period fertility indicator using all available cohort information; (2) captures the dynamics of parity transitions; and (3) links information on fertility quantum and timing together as part of a single phenomenon. Using data from the Human Fertility Database, we calculate CALP for 12 countries in the Global North. Our results show that women spend the longest time at parity zero on average, and in countries where women spend comparatively longer time at parity zero, they spend fewer years at parities one and two. The analysis is extended by decomposing the differences in CALPs between Sweden and the United States, revealing age- and cohort-specific contributions to population-level differences in parity-specific fertility patterns. The decomposition illustrates how high teenage fertility in the United States dominates the differences between these two countries in the time spent at different parities.

Sibling group size and BMI over the life course: Evidence from four British cohort studies

Only children, here defined as individuals growing up without siblings, are a small but growing demographic subgroup. Existing research has consistently shown that, on average, only children have higher body mass index (BMI) than individuals who grow up with siblings. How this difference develops with age is unclear and existing evidence is inconclusive regarding the underlying mechanisms. We investigate BMI trajectories for only children and those with siblings up to late adolescence for four British birth cohorts and across adulthood for three cohorts. We use data on BMI from ages 2-63 years (cohort born 1946); 7-55 years (born 1958); 10-46 (born 1970) and 3-17 years (born 2000-2002). Using mixed effects regression separately for each cohort, we estimate the change in BMI by age comparing only children and those with siblings. The results show higher average BMI among only children in each cohort, yet the difference is substantively small and limited to school age and adolescence. The association between sibling status and BMI at age 10/11 is not explained by differential health behaviours (physical activity, inactivity and diet) or individual or family background characteristics in any of the cohorts. Although persistent across cohorts, and despite the underlying mechanism remaining unexplained, the substantively small magnitude of the observed difference and the convergence of the trajectories by early adulthood in all cohorts raises doubts about whether the difference in BMI between only children and siblings in the UK context should be of research or clinical concern. Future research could usefully be directed more at whether only children experience elevated rates of disease, for which high BMI is a risk factor, at different stages of the life course and across contexts.

Fertility intentions among young people in the era of China's three-child policy: a national survey of university students

Background

This study aimed to assess the fertility intentions of young people after the announcement of the three–child policy in China and to determine whether knowledge about reproductive, maternal, newborn, and child health (RMNCH) services or support, childbearing- and childbirth-related anxiety, and parenthood–related anxiety influence fertility intentions.

Methods

A cross-sectional Internet-based survey was conducted on a nationwide sample of young people aged 18 to 28 years old in education institutions. Factors associated with fertility intentions were analysed using partial least squares structural equation modelling (PLS-SEM).

Results

Only 4.2% of males and 1.7% of females intended to have three children or more. On the whole, the majority (40.3%) reported the intention to have two children. The mean and standard deviation (SD) for the total knowledge RMNCH support and/or services knowledge score was 9.5 (SD ± 8.9), out of a possible score of 39. The median and interquartile range (IQR) of childbearing– and childbirth-related anxiety score was 8.0 (IQR = 6.0–9.0), out of a possible score of 10. The median and IQR of parenthood–related anxiety score among the males was 6.0 (IQR = 4.0–9.0) and for females was 7.0 (IQR = 5.0–9.0). Results from PLS-SEM revealed that a higher level of knowledge of RMNCH support and/or services is significantly associated with higher fertility intentions. Both childbearing- and childbirth-related anxiety and parenthood–related anxiety were inversely associated with fertility intentions.

Conclusion

Raising awareness about RMNCH supportive measures and easing birth- and parenting anxiety are imperative to enhance birth rates. Future policies should pay more attention to these determinants to achieve their intended goal of boosting population growth.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04873-y.

Patterns of help and care by adult only children and children with siblings

Adult children with siblings can share caring for older parents but adult only children face this responsibility alone. Given increased longevity and reliance on informal care-giving, as well as an increase in one-child families, there is a need to investigate only children's care-giving further. Using data from three large-scale British birth cohorts, this paper investigates patterns of parent-care, care intensity and wellbeing at ages 38 and 42 (N = 17,255, N = 16,703; born 1970), 50 and 55 (N = 12,775, N = 11,339; born 1958) and 63 (N = 2,364; born 1946), how sibling composition intersects with gender in relation to care-giving and whether different care-giving patterns are associated with wellbeing. Only children are more likely to provide parent-care and the pattern is consistent with an interpretation that differences by sibling status might increase with age. Provision is gendered, and the sibling group composition matters for involvement. Although care-giving is related to wellbeing, we found no evidence that this differs between only children and those with siblings. The literature on only children has hitherto focused largely on childhood, suggesting that on some outcomes they benefit from a concentration of parental resources. Our results suggest that in middle adulthood parental care needs may instead be concentrated for the only child without the ‘resource’ of siblings. This indicates a need to develop further our understanding of this growing demographic subgroup.

China's fertility change: an analysis with multiple measures

Background

The period fertility in China has declined to very low levels, and the completed cohort fertility rate (CFR) has also decreased significantly. However, the exact fertility rate remains controversial. While the tempo effect has played a significant role in China’s period fertility decline, child underreporting has to be taken into consideration in China’s fertility research.

Methods

By using the census data from 1982 to 2010, and the 1% population sample survey data from 1995 to 2015, we systematically analyzed China’s fertility and its trends since the 1980s using period fertility measures, adjusted period fertility measures, cohort fertility measures, and indirect estimation methods.

Results

The results show that marriage postponement significantly affects the TFR decline. Even after eliminating the tempo and parity structure effect, the adjusted TFR has fallen below 1.5, and the first-order fertility rate dropped to 0.9 in 2015. The CFR for women aged 45–49 declined from 5.37 in 1982 to 1.62 in 2015 mainly because of a decrease in fourth and higher-order births from 1982 to 1990, a decrease in second and third births from 1990 to 2000, and a decrease in second births from 2000 to 2015. Indirect estimation methods yielded a TFR in the range of 1.5–1.6 for the period 2000–2010 and an average TFR of 1.49 for the period 2011–2020.

Conclusions

The traditional norm of universal marriage and childbearing for Chinese women is changing. China’s fertility has been steadily declining, as measured by both period and cohort indicators. Following the historical change, fertility may continue to decline even after introducing the universal three-child policy in China in 2021.

The Terror Management Function of Descendent Continuity: Evidence That Descendent Continuity Acts as a Distal and Proximal Defense

Previous researches showed that offspring can function as a distal defense, we presented seven studies to further explore the role of offspring in terror management for Chinese people based on their unique fertility culture. Both Studies 1a and 1b found that mortality salience increased desire for children. Study 2 showed that offspring salience reduced the effect of mortality salience on social transgressions judgments. Study 3 revealed that disruption of procreation strivings increased death-thought accessibility. Study 4 demonstrated that conscious responses to worldview threats overwhelmed the unconscious compensation effect of worldview threats on desire for children. Study 5a and Study 5b found that offspring salience decreased death anxiety for parents and nonparents. Taken together, these findings expand terror management theory, emphasizing descendent continuity not only as a related yet separate distal defense from the cultural worldviews, self-esteem, and close relationship but also as a proximal defense, especially for Chinese.

Work and fertility in Taiwan: how do women's and men's career sequences associate with fertility outcomes?

There has been much debate over the micro-level relationship between employment situations and fertility in Europe and Northern America. However, related research in East Asia is scant, although countries in this region have some of the lowest fertility rates in the world. Moreover, most studies analyse the employment-fertility relationship from a static perspective and only for women, which underemphasises life course dynamics and gender heterogeneity of employment careers and their fertility implications. Drawing on retrospective data from the 2017 Taiwan Social Change Survey (TSCS), this study explores women's and men's career trajectories between ages 18 and 40 in Taiwan using sequence cluster analyses. It also examines how career variations associate with different timing and quantum of birth. Empirical results show that economically inactive women experience faster motherhood transitions and have more children by age 40 than women with stable full-time careers. For men, having an unstable career associates with slower fatherhood transitions and a lower number of children. For both genders, self-employed people are the earliest in parenthood transitions and have the highest number of children by midlife. Our findings demonstrate sharp gender contrasts in employment careers and their diversified fertility implications in low-fertility Taiwan.

Motherhood in Spain: From the "Baby Boom" to "Structural Infertility"

We analyze the mechanisms of reproductive governance that influence reproduction in Spain through 66 semi-structured interviews with heterosexual parents. We examine reproductive governance through moral regimes surrounding four arenas: the labor market, gender relations at home, institutional feminist discourses, and the narrative of choice. We show that mothers are considered to be socially responsible for children, a fact that is key to understanding how Spain went from a "baby boom" between the 1950 and 1970s to "structural infertility" since the 1990s.

Stress, Fatigue, and Sexual Spontaneity Among Married Couples in a High-Stress Society: Evidence from Sex Diary Data from Singapore

This paper investigates the associations between stress and fatigue and sexual spontaneity among heterosexual married couples in Singapore, a high-income society with high work performance expectations and long working hours. Data on self-reported menstrual dates, sexual activity within the marriage, and stress and fatigue levels were collected from 657 married women aged 25-34 years through biweekly online diaries over 14 weeks. Using a two-way fixed effects logistic model which controlled for time-invariant individual fixed effects and menstrual cycle fixed effects, the paper tests three hypotheses: (1) sexual activity is significantly lower on weekdays compared to weekends and public holidays, (2) sexual activity is significantly lower during periods when women reported higher stress and fatigue, and (3) stress and fatigue are more predictive of sexual activity during weekdays than during weekends. Frequencies of marital sexual intercourse during the diary keeping period were 3.69 and 2.55 per 30 days among women aged 25-29 and 30-34 years, respectively, much lower than ideal frequencies of 6.40 and 5.23. Consistent with all three hypotheses, there was a strong positive weekend effect and a weak but positive public holiday effect, and strong negative effects of both stress and fatigue, especially during weekdays. There was no evidence of compensatory sex on weekends to make up for hectic workweeks. Increased support for work-life balance can contribute to more spontaneous marital sex lives and may reduce underachievement of ideals for sexual intimacy and childbearing in Singapore.

The Korean Pregnancy Outcome Study (KPOS): Study Design and Participants

BACKGROUND

The Korean Pregnancy Outcome Study (KPOS) was established to investigate the determinants of adverse pregnancy outcomes among Korean women.

METHODS

We recruited 4,537 pregnant women between 2013 and 2017 from two tertiary centers located in Seoul, Korea, and a total of 4,195 Korean women met inclusion criteria in the baseline analysis. A range of data on socio-demographics, past medical histories, reproductive information, health-related behaviors, psychological health and clinical information were obtained using interviewer-based questionnaires and clinical assessment at 12, 24, and 36 gestational weeks (GW), delivery and 6-8 weeks postpartum. Blood samplings were performed at 12, 24 and 36 GW, and placental tissues were obtained after delivery. The main outcome of this study was pregnancy-related complications including gestational diabetes mellitus (GDM), gestational hypertension, and screening positive for peripartum depression. Depression was assessed using the Korean version of the Edinburgh Postnatal Depression Scale, and a score of ≥10 indicated a positive screen for depression.

RESULTS

Among 4,195 eligible pregnant women with a median age of 33.0 years, 3,565 (85.0%) pregnancy outcomes were available in this study, including 30 miscarriages, 16 stillbirths, and 3,519 deliveries. Mean gestational age was 38.8 GW, and mean birth weight was 3,236 gram. The prevalence of pregnancy complications of GDM, hypertensive disorders, and screening positive of depression during pregnancy and postpartum was 7.0%, 1.4%, 27.8%, and 16.6%, respectively.

CONCLUSIONS

We designed KPOS to identify the determinants of pregnancy-related outcomes, and it may provide effective strategies for the prevention of pregnancy complications in Korean pregnant women.

Cross-Sectional Average Length of Life Childless

Increases in the average age at first birth and in the proportion of women remaining childless have extended the total number of years that women spend childless during their reproductive lifetime in several countries. To quantify the number of years that reproductive-age women live without children, we introduce the cross-sectional average length of life childless (CALC). This measure includes all the age-specific first-birth information available for the cohorts present at time t; it is a period measure based on cohort data. Using the Human Fertility Database, CALC is calculated for the year 2015 for all countries with long enough histories of fertility available. Results show that women in the majority of the studied countries spend, on average, more than half of their reproductive lives childless. Furthermore, the difference between CALCs in two countries can be decomposed to give a clear visualization of how each cohort contributes to the difference in the duration of the length of childless life in those populations. Our illustration of the decomposition shows that (1) in recent years, female cohorts in Japan and Spain at increasingly younger ages have been contributing to more years of childless life compared with those in Sweden, (2) the United States continues to represent an exception among the high-income countries with a low expectation for childless life of women, and (3) Hungary experienced a strong period effect of the recent Great Recession. These examples show that CALC and its decomposition can provide insights into first-birth patterns.

Increasing trends in incidence of preterm birth among 2.5 million newborns in Guangzhou, China, 2001 to 2016: an age-period-cohort analysis

Background

The incidence of preterm birth (PTB, < 37 weeks of gestation) has been increasing in China and many other countries in recent years. However, the causes of the increase were not well understood. The current study aims to examine the contribution of maternal age, period of delivery, and maternal birth cohorts to long-term trends in preterm birth in Guangzhou, China.

Methods

In a retrospective population-based study, data were obtained from 2,535,000 singleton live births with 20–43 gestational weeks from 2001 to 2016 and recorded in the Guangzhou Perinatal Health Care and Delivery Surveillance System, in China. The age-period-cohort models were applied to investigate the temporal changes in incidences of PTB, stratified by parity.

Results

The incidence of preterm birth steadily increased from 5.1% in 2001 to 5.9% in 2016, with larger rise in primiparous mothers (from 5.0 to 5.9%) compared to multiparous mothers (from 5.6 to 5.9%). A J-shaped and a V-shaped relationship were found between maternal age and PTB among primiparous and multiparous mothers, respectively. A linear cohort effect was found among primiparous mothers with the lowest risk of PTB [risk ratio (RR) = 0.81, 95% confidence interval (CI): 0.74 to 0.89] in 1961 and the highest risk (RR = 1.06, 95% CI: 1.00 to 1.13) in 1997 compared to the mothers born in 1981. An inverse U-shaped association between maternal birth cohort and PTB was found in multiparous mothers. There were weak decreasing period effects on the trend of overall PTB among multiparous mothers and on the trend of extremely (< 27 weeks) or very (28–31 weeks) PTB among both parity groups during the period of 2001–2012.

Conclusions

Our findings showed the PTB incidences had been increasing in the past 16 years in Guangzhou, China and both maternal age and cohort effects contributed to these trends. Further studies are recommended on the impact of altered maternal age and parity on premature births and corresponding public education and public health policies.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12889-020-09739-6.

Kinlessness Around the World

OBJECTIVES

The first and second demographic transitions have led to profound changes in family networks. However, the timing and extent of these transitions vary widely across contexts. We examine how common it is for contemporary older adults to lack living kin and whether such individuals are uniformly disadvantaged around the world.

METHODS

Using surveys from 34 countries that together contain 69.6% of the world's population over age 50 and come from all regions of the world, we describe the prevalence and correlates of lacking immediate kin. We examine macro-level demographic indicators associated with the prevalence of kinlessness as well as micro-level associations between kinlessness and sociodemographic and health indicators.

RESULTS

There is great variation in levels of kinlessness, from over 10% with neither a spouse nor a biological child in Canada, Ireland, the Netherlands, and Switzerland to levels below 2% in China and the Republic of Korea. There are strong macro-level relationships between kinlessness and lagged or contemporaneous fertility, mortality, and nuptiality measures and more marginal relationships with other demographic forces. Micro-level associations between kinlessness and respondent attributes are varied. The kinless are more likely to live alone than those with kin in all countries. In most countries, they have equivalent or worse self-rated health and lower education, although there are notable exceptions. There is substantial variation in the gender composition of the kinless population.

DISCUSSION

As demographic changes affecting kinlessness continue, we expect the scale of the kinless population to grow around the world.

The second demographic transition, 1986–2020: sub-replacement fertility and rising cohabitation—a global update

The article considers the evolution of two “Second Demographic Tradition” (SDT) core characteristics: fertility postponement and the rise of cohabitation, with particular attention being given to the first two decades of the new century. It can be considered as the sequel to the concise overview of the SDT published earlier in the US Proceedings of the National Academy (PNAS) (Lesthaeghe, 2014).

In the first section, three optimistic views concerning the evolution of fertility are considered: (i) rises due to the end of postponement, (ii) rises connected with advancing human development and (iii) rises associated with advancing gender equality. The focus in this section is mainly but not exclusively on the European experience and its large degree of variation in fertility patterns. It is argued that these three optimistic predictions of sustained fertility rises are mainly based on observations prior to 2010, with too much weight being given to four Nordic countries and too little to other Western European countries with very similar fertility levels. However, these expectations have been thwarted during the second decade, even in the presence of advances in human development and/or gender equality. Hence, the original SDT prediction of 1986 of sustained sub-replacement fertility still holds after 35 years. We expect this to continue during the third decade as well. Furthermore, single-factor explanations are not likely to do justice to far more intricate situations that are responsive to varying structural and ideational influences.

In the second section, the evolution of cohabitation is traced in Europe, the USA and Canada, the Latin American countries, three East Asian populations and selected sub-Saharan cases. At the onset, cohabitation can start either from a SDT basis among the better educated or among the poorer classes following a pattern of disadvantage (POD). It is argued that the feature of cohabitation spreads rapidly among all social classes and across all education groups and that in the process of increasing cohabitation, the POD versus SDT argument loses its significance. On a global scale, the rise in cohabitation is contingent on two dimensions: (i) contrasting historical patterns of kinship organisation, including the position of women, and (ii) further advances of the “ethics revolution”, indicating the growing dominance of individual autonomy over traditional societal norms. As a result, no breakthroughs in the near future are expected in countries with a Muslim or Hindu tradition in which no such major cultural shifts have occurred so far.

Latest-Late Fertility? Decline and Resurgence of Late Parenthood Across the Low-Fertility Countries

After decades of fertility postponement, we investigate recent changes in late parenthood across low-fertility countries in the light of observations from the past. We use long series of age-specific fertility rates from the Human Fertility Database (1950-2016) for women, and new data covering the period 1990-2016 for men. In 1950, the contribution of births at age 40 and over to female fertility rates ranged from 2.5 to 9 percent, but then fell sharply until the 1980s. From the 1990s, however, the prevalence of late first births increased rapidly, especially so in countries where it was initially lowest. This has produced a late fertility rebound in the last two decades, occurring much faster for women than for men. Comparisons between recent and past extremely late (age 48+) fertility levels confirm that people are now challenging the natural fertility barriers, particularly for a first child.

Childlessness and union histories: evidence from Finnish population register data

From an evolutionary perspective, childlessness may be considered a failure, as it implies that there will be no direct transmission of one's genetic material to later generations. It is also a pressing social issue, because in many contemporary advanced societies, levels of childlessness have increased, and particularly so among men. The absence of a partner is naturally a fundamental determinant of childlessness. Empirical evidence on how childlessness relates to individuals' partnership histories is nevertheless limited. This issue was analysed with Finnish population register data, which allow the complete cohabitation and marriage histories of individuals from age 18 years to be observed. For women and men born between 1969 and 1971, logistic regression models were estimated for childlessness at age 40 by partnership histories in terms of various stages in the process of union formation and dissolution, and accounting for several socioeconomic variables. A strong link between union histories and childlessness was found, with short partnership spells raising the risk of not becoming a parent. Later age when leaving the parental home raised female childlessness, while a short first-union duration related more strongly to male childlessness. These findings may be considered as providing insights into how specific life-history strategies affect reproductive outcomes, and highlight the need to develop new approaches to understand this feature of social inequality.

Maternity migration and the recent normalization of the sex ratio at birth in Hong Kong

Hong Kong is characterized by very low fertility. However, over a period from 2000 to 2015, both the total number of births and the sex ratio at birth (SRB) increased and then declined dramatically. We analysed the increases in a 2013 paper in this journal, where we largely ascribed them to a rapid growth in the number of 'transient' mothers from Mainland China disproportionately giving birth to boys in the territory. In 2012, policies were implemented to halt this 'maternity migration'. Here, we explore the impact of these policies, both on births and the SRB in Hong Kong. We conclude that the rises and falls in births and SRBs in Hong Kong can, indeed, be broadly ascribed to the reproductive behaviour of transient Mainland mothers. However, the role of the Hong Kong government's policy interventions is much less clearly defined.

Intention of having a second child among infertile and fertile women attending outpatient gynecology clinics in three major cities in China: a cross-sectional study

STUDY QUESTION

What is the intention to have a second child among women attending outpatient gynecology clinics in three major cities in China?

SUMMARY ANSWER

In total, 69.3% of the participants expressed the intention to have a second child and this was related to infertility status, pronatalist attitudes, and sociodemographic factors.

WHAT IS KNOWN ALREADY

In 2016, the new universal two-child policy was introduced in China enabling all Chinese couples to have a second child. A government-led national survey revealed that the majority of women included under the policy would be 35 years old and older and thus would be at higher risk of infertility. Previous studies found that fertility intention differs by infertility status.

STUDY DESIGN, SIZE, DURATION

A cross-sectional survey was performed to examine the intention of having a second child and its associated factors among infertile and fertile women attending gynecology outpatient clinics in three major cities in China. Clinical nurses approached eligible women in person while waiting for their consultations. Recruitment and data collection were conducted from April to August 2016.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey involved four gynecology outpatient clinics in Beijing, Shenzhen, and Hohhot. Married women aged 20–45 years who were seeking outpatient gynecology care for non-malignant problems were invited to participate.

MAIN RESULTS AND THE ROLE OF CHANCE

Data from 974 women were included in the analysis. A total of 69.3% of the women expressed the intention to have a second child, and infertile women were more likely to want a second child compared to fertile women (76.6% vs 61.9%, respectively; P < 0.001). Greater ideal parity facilitated the intention for a second child in both groups, while pronatalist attitudes (meaning that they preferred to have their first childbirth at a younger age and attached greater significance to traditional childbearing beliefs), unexplained infertility, presence of a living child and religious affiliation were associated with greater intention among infertile women. In contrast, in the fertile group, older age, full-time work and lower confidence in achieving parity goals diminished the intention for a second child. Although infertile women displayed greater agreement with pronatalist attitudes and desired a higher ideal parity, they had less confidence in achieving their parity goals than their fertile counterparts.

LIMITATIONS REASONS FOR CAUTION

In addition to self-report and self-selection bias, our participants were recruited from urbanized areas and were more educated than the general population. Owing to the extremely busy environment in the clinics, difficulties were encountered in keeping track of the number of women whom the nurses approached, and the response rate was therefore unavailable.

WIDER IMPLICATIONS OF THE FINDINGS

With the introduction of the universal two-child policy, there is a need to enhance fertility awareness and to encourage reproductive life planning, as well as to lower the cost of childcare, in order to increase the birth rate in China. Effort is required to make childbearing more compatible with current employment, career and educational development, the burdens of family care (e.g. for elderly parents), social environments and cultural expectations. This is particularly relevant for families who already have a child, as our findings show that their hesitation toward a second child was largely related to difficulties with extra childcare within the woman’s current work and family life.

STUDY FUNDING/COMPETING INTEREST(s)

This study did not receive any funding. The authors declared no competing interests.

TRIAL REGISTRATION NUMBER

Not applicable.

FAR BELOW REPLACEMENT FERTILITY IN URBAN CHINA

China's urban population has experienced rapid fertility decline over the past six decades. This drastic change will have a significant impact on China's demographic, social and economic future. However, the patterns and characteristics of urban China's fertility decline have not been systematically examined. This study analyses the trends and age patterns of fertility in urban China since the 1950s, and summarizes the major characteristics of reproductive behaviours into four 'lows': extremely 'low' level of fertility; 'low' proportion of two and higher parity births; 'low' mean age at birth; and 'low' level of childlessness. The paper argues that the highly homogenous reproductive behaviours found in China's now near 800 million urban population have been in part shaped by the country's unprecedented government intervention in family planning. The 'later, longer, fewer' campaign in the 1970s and the 'one-child' policy, in particular, have left clear imprints on China's reproductive norms and fertility patterns. The government-led family planning programme, however, has not been the only driving force of fertility decline. A wide range of social, economic, political and cultural changes have also affected the transition in family formation, reproductive behaviour and fertility patterns, and this has become increasingly prominent in the past two decades.

The changing relationship between marriage and childbearing in Hong Kong

Births outside marriage (BoM) account for around 15% of all births globally. However, the distribution around the world is very uneven, as are cultural and political attitudes towards them. Studies from East Asia have shown that the percentage of such births is very low, with only modest increases in recent years. The orthodox demographic view holds that the maintenance of conservative views around the relationship between marriage and childbearing can play a role in keeping fertility low. Prenuptial pregnancies (PNP) (where births occur within eight months of marriage) have been identified as a growing phenomenon in Japan, possibly being an ‘alternative’ Asian pathway to family formation. As yet, no comprehensive statistical analysis of the trends of BoM or PNP has been performed for Hong Kong. Using a comprehensive microdata set of birth registration in Hong Kong from 1984–2015 (N = 1,680,831) we provide evidence of recent trends in such ‘alternative pathways’ to family formation and examine predictors through regression analysis. Our results indicate, in common with elsewhere in East Asia, low overall period rates of either BoM or PNP (although the latter has risen notably in recent years). While more recent birth cohorts exhibit higher prevalence of such births, their incomplete nature and higher expected propensity suggests that the figures are exaggerated. In our regression analysis, we find that lower educational attainment is a strong predictor of both BoM and PNP, suggesting that a bifurcation of experience may be occurring. This adds further evidence to the theory that the maintenance of traditional family formation systems in the context of revolutionised educational and work opportunities for women mean that the opportunity costs of the ‘marriage package’ become too high. Current disparities in rights and privileges between married and unmarried parents–and especially their children–means that targeted family planning services and support for vulnerable families are policy priorities.

THE SECOND DEMOGRAPHIC TRANSITION THEORY: A Review and Appraisal

References to the second demographic transition (SDT) concept/theoretical framework have increased dramatically in the last two decades. The SDT predicts unilinear change toward very low fertility and a diversity of union and family types. The primary driver of these changes is a powerful, inevitable and irreversible shift in attitudes and norms in the direction of greater individual freedom and self-actualization. First, we describe the origin of this framework and its evolution over time. Second, we review the empirical fit of the framework to major changes in demographic and family behavior in the U.S., the West, and beyond. As has been the case for other unilinear, developmental theories of demographic/family change, the SDT failed to predict many contemporary patterns of change/difference. Finally, we review previous critiques and identify fundamental weaknesses of this perspective, and provide brief comparisons to selected alternative approaches.

Fertility in China: An uncertain future

As one of the world’s two population ‘billionaires’, the future of China’s population is truly of global significance. With its very low fertility and a rapidly ageing population, it might appear that the country’s famous (or notorious) family planning restrictions are somewhat anachronistic. Here, we explore the process of reform seen over the past three decades and, most recently, in late 2013. We suggest that the popular notion that the family planning restrictions are acting as a pressure valve suppressing a pent-up demand for childbearing, particularly in rural China, is likely to be inaccurate. We also suggest that further reform of the restrictions will not solve the problems of population ageing or many of the other issues widely associated with the restrictions. We conclude that the prospects for further reform are wide-ranging, but likely to be beset by many challenges.