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

"Hit a bottleneck": a convergent mixed-methods approach to the Influencing factors and experience of fertility intention among mothers of childbearing age with two children in mainland China

BACKGROUND

Fertility rates have been decreasing both worldwide and in China. Although current policies have been aimed at raising the birth rate in China, their overall effects have been unclear. Therefore, exploration of fertility intention and related influencing factors is crucial.

METHODS

This study used a convergent parallel mixed methods combining descriptive and cross-sectional designs with a framework analysis. Convenience sampling was used to select mothers of childbearing age with two children (n = 603), living in Guangdong Province, China. Participants completed an online questionnaire investigating sociodemographic characteristics, as well as determinants and attitudes regarding the third-child fertility intention. Correlation coefficients and multivariate regression analyses were used to present quantitative findings. Eleven interviews were conducted, and a framework analysis method was used for data analysis. The results for the qualitative and quantitative study components were analyzed separately and were subsequently integrated through side-by-side comparison and joint display.

RESULT

Attitudes toward fertility intention were negative, and the rate of fertility intention was 10.4% in Guangdong Province. In the quantitative component, women's age, perceived value of having a third child, and attitudes were found to be factors promoting the intention to have a third child, whereas monthly family income, grandparents' health status, and policy support were found to be factors hindering the intention to have a third child. Four major themes emerged regarding the perceptions and experiences regarding fertility intention in the qualitative component. After integrated analysis, younger age, knowledge regarding policy support, and access to childcare support were found to be factors significantly affecting the intentions of mothers with two children regarding having a third child.

CONCLUSION

Fertility issues require continued attention. Our findings provide a reference for optimizing existing policies to increase fertility intentions. Providing policy support, such as public childcare support, flexible working hours for mothers, affordable childcare, and greater psychological support, would enable mothers to improve their parenting. In addition, increasing the dissemination of knowledge regarding policies is necessary to improve the level of public understanding and promote fertility intention.

Demographic transition in South Korea: implications of falling birth rates

This review examines the critical issues of declining total fertility rates (TFRs) and aging populations in East Asia with special focus on South Korea. It provides a comprehensive analysis of TFR trends, aging demographics, and the policy responses of these nations to the low-fertility crisis. This study highlights the intricate tapestry of the factors contributing to these demographic shifts, including economic, social, and cultural influences. It also examines the effectiveness of various prenatal policies implemented across these countries, offering insight into their successes and limitations. Furthermore, it explores the role of immigration as a potential solution to the structural challenges posed by low birth rates. This review underscores the importance of multifaceted strategies for addressing the complex demographic challenges faced by South Korea.

Associations between live birth and cardiometabolic disease in Southwest Chinese women

BACKGROUND

China has undergone a significant socioeconomic transformation over the past few decades due to the implementation of family planning policies. These societal changes have resulted in an increased susceptibility among females to developing cardiometabolic diseases (CMD). Unfortunately, studies investigating the correlation between family planning policies in China and the incidence of CMD remain scarce.

METHODS

Data from 1,226 females, aged 30 years or older with ≥ 1 live birth, undergoing routine physical examinations between January 2018 and December 2021 were collected, and they were grouped by number of live births 1, 2, and ≥ 3. A binary logistic regression model was employed to examine the association between the number of live births with CMD. Furthermore, the subgroup analysis was performed to elucidate the impact of the implementation of family planning policies with CMD.

RESULTS

Women with live births ≥ 3 tended to be older, had higher gravidities, a greater proportion of central obesity, general obesity, hypertension, and dyslipidemia (all P < 0.05). Across the three groups (live birth = 1, =2 and ≥ 3), the odds ratio (OR) with 95% CI for obesity were: 1.00, 3.32 (2.36-4.69), and 5.73 (3.79-8.68); for dyslipidemia were: 1.00, 1.75 (1.29-2.39), and 2.02 (1.38-2.94); and for CMD were: 1.00, 1.91 (1.44-2.54), and 2.15 (1.46-3.15), respectively (all P < 0.05). In addition, based on the different periods of the childbearing policy in China, a subgroup analysis (where age was divided into ≤ 45, 45-65, and ≥ 65 years old) found that each additional live birth increased the prevalence risk of obesity and CMD in the younger generations, while hypertension and dyslipidemia in the elder generation.

CONCLUSIONS

Higher live births are positively associated with the prevalence of CMD among women in Southwest China. Moreover, giving birth after the implementation of the one-child policy tends to have a higher risk of developing CMD.

Fertility Intentions Among Reproductive-Age Women - Three Provinces, China, 2023

What is already known about this topic?

Low fertility rates have become the most important risk affecting the balanced development of the population in China.

What is added by this report?

About 80.0% of childless women had fertility intentions, 31.9% of women with one child and 11.3% of women with two children intended to have a second and third child, respectively. Women with one child who had an agricultural Hukou, were younger than 30 years old, were remarried, and had received a deduction or reimbursement for childbirth expenses during their first delivery were more willing to have a second child. Women with two children who had an agricultural Hukou and a upper-middle personal income, were self-employed, and had two daughters were more willing to have a third child.

What are the implications for public health practice?

In China, women's willingness to have more children is not optimistic. To increase their desire for more children, creating a more favorable fertility environment for reproductive-age women and providing more preferential fertility policies for pregnant women will be necessary.

Status, outcome, and related factors of postpartum hypertension in the Shanghai community

BACKGROUND

Postpartum hypertension poses a considerable health risk. Despite research on gestational hypertension, comprehensive studies focusing on postpartum hy-pertension in communities are limited. Understanding its prevalence and associated risk factors is crucial for effective prevention and management.

AIM

To provide insights for postpartum hypertension's prevention and management.

METHODS

In total, 3297 women who gave birth between June 2021 and December 2022 in Xuhui District, Shanghai were selected. Blood pressure was measured thrice within one month post-delivery during home visits. Eighty-six women with hypertension were followed up for four months to analyze hypertension per-sistence and its related risk factors. A predictive model for persistent postpartum hypertension was established and verified using the Nomo diagram model.

RESULTS

Hypertension prevalence 1 month post-delivery was 2.61% (86/3297). Among the 86 pregnant women, 32 (37.21 %) had persistent hypertension at four months post-delivery. Multivariate logistic regression analysis revealed that older age [odds ratio (OR) = 1.212; 95% confidence interval (CI): 1.065-1.380] and higher pre-pregnancy body mass index (BMI) (OR = 1.188; 95%CI: 1.006-1.404) were associated with hypertension (OR = 10.781; 95%CI: 1.006-1.404) during pregnancy. A 95%CI of 1.243-93.480 is a risk factor for persistent postpartum hypertension. The Nomograph model accurately predicted the risk of persistent postpartum hypertension, demonstrating high precision.

CONCLUSION

In Xuhui, older age, higher pre-pregnancy BMI, and gestational hypertension are risk factors for persistent postpartum hypertension. Our prediction model can identify high-risk individuals, thereby improving patient quality of life.

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.

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 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.

Fertility intentions to have a second or third child among the childbearing-age population in Central China under China's three-child policy: A cross-sectional study

Background

On May 31, 2021, the Chinese authorities announced that couples can have up to three children, aiming to stimulate a rise in fertility levels. However, there is limited research on second and third birth intentions of the childbearing-age population under China's three-child policy, and the existing results are inconsistent.

Methods

A cross-sectional survey was performed in Central China from June to August 2022. A total of 13 479 respondents aged 20-49 were enrolled in the study through a multi-stage sampling method. Data on the intentions to have a second or third child were collected using anonymized questionnaires. Descriptive statistics were performed to assess fertility intentions. Multivariate logistic regression analyses were used to assess the associations between fertility intentions and the related factors.

Results

Among families with a single child, 29.7% (1444 / 4859) of the respondents intended to have a second child, while among two-child families, 10.6% (750 / 7056) respondents intended to have a third child. Overall, participants indicated that the ideal number of children was 1.85 ± 0.52. The age-specific fertility intentions of the one-child families were always higher than those of two-child families; however, based on couples' age groups, the number of ideal children reported by two-child families was always higher than that of one-child families. Fertility intentions were influenced by the respondents' gender, age, residence, marital status, educational level, average working time, childcare support, marital satisfaction, accessibility of educational resources, health condition of both spouses, loan situation, size of living house and the gender of the first child or second child.

Conclusions

The general prevalence of the second and third birth intention of the childbearing-age population in Central China is not high. To increase the birth rate, it is necessary to create a favourable fertility context and offer supportive measures.

Summary of the effect of an exercise intervention on antenatal depression and the optimal program: a systematic review and Meta-analysis

OBJECTIVE

This study aimed to examine the effect of exercise intervention for antenatal depression using meta-analysis and to propose the best exercise intervention program.

METHODS

Review Manager 5.3 was used to analyze 17 papers with 2224 subjects by setting five moderators, including type, time, frequency, period, and format of exercise intervention, and a random-effects model was used to test for overall effect, heterogeneity, and publication bias.

RESULTS

(1) The effect size of the exercise intervention on antenatal depression was d = -0.56, which reached a good effect and was statistically significant; b (2) The effect size of the exercise type on antenatal depression was Yoga and a combination of aerobic exercise in order of intervention; (3) the single intervention duration of 10-75 min all had a good effect on antenatal depression, and 30-60 min had the best effect; (4) the intervention frequency of 3 to 5 times/week had the greatest amount of intervention effect on maternal depression; (5) exercise lasting 6-10 weeks had a good intervention effect on antepartum depression, and the amount of effect decreased gradually with the extension of time; (6) In terms of exercise format, the amount of intervention effect on maternal depression was in the order of group exercise, individual + group exercise.

CONCLUSIONS

Exercise intervention can significantly alleviate antenatal depression symptoms. The best exercise program for exercise intervention for antenatal depression is: Yoga and a combination of aerobic exercise intervention effects are more prominent, and the intervention effect of Yoga is the best. The use of group exercise 3-5 times per week for 30-60 min for 6-10 weeks was more likely to achieve the desired intervention effect of improving antenatal depression.

Midwife empathy and its association with the childbirth experience: a cross-sectional study

BACKGROUND

Although pregnancy and childbirth comprise a life-course that most midwives experience, whether their own experiences of childbirth resonate with other women during childbirth remains to be determined. In this study, we therefore characterized midwives' empathic capabilities and defined their underlying factors.

METHOD

We conducted a cross-sectional study with data from 464 midwives in Guangdong, China, that were collected through the "Chinese version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP)." This questionnaire contains sections related to midwife demographics and delivery characteristics. We then implemented multivariate logistic regression analysis to identify empathy-related factors.

RESULTS

Our analysis revealed 303 (65.3%) participants in the high-empathy group while 161 (34.7%) were in the middle-empathy group. Compared with the reference groups, these results indicated that higher empathy was associated with an elevated educational level (OR, 1.83; 95% CI, 1.04-3.25), high monthly salary (OR, 2.30; 95% CI, 1.11-4.80), and no shift work (OR, 2.89; 95% CI, 1.09-7.63). The odds of a high empathy score were higher for midwives who experienced two childbirths (2.27, 1.11-4.66) and for those who had children under the age of 3 years (2.81, 1.34-5.92).

CONCLUSION

Midwives possess a moderate-to-high level of empathy, and the greater the number of childbirths they experienced and the younger their children, the higher their reported empathy score. This study contributes novel information regarding the empathic behavior of midwives toward women who give birth in China.