Association of China’s universal two child policy with changes in births and birth related health factors: national, descriptive comparative study

Abstract

ObjectiveTo measure the association of China’s universal two child policy, announced in October 2015, with changes in births and health related birth characteristics.DesignNational, descriptive before-and-after comparative study.SettingEvery county in 28 of 31 provinces of mainland China.ParticipantsBirths included in two national databases: 67 786 749 births from county level monthly aggregated data between January 2014 and December 2017; and 31 786 279 deliveries from individual level delivery information records between January 2015 and December 2017.Main outcome measuresMonthly mean number of births and mean proportion of multiparous mothers and mothers aged 35 and over, preterm deliveries, and caesarean deliveries.ResultsThe study had two phases: the baseline period (up to and including June 2016, nine months after the policy announcement) and the effective period (from July 2016 to December 2017). The estimated number of additional births attributable to the new policy between July 2016 and December 2017 was 5.40 million (95% confidence interval 4.34 to 6.46). The monthly mean percentage of multiparous mothers and mothers aged 35 and over increased by 9.1 percentage points (95% confidence interval 6.4 to 11.7) and 5.8 percentage points (5.2 to 6.4), respectively. This increase in older mothers, however, was not associated with a concurrent increase in the overall rate of preterm birth. The monthly mean caesarean delivery rate among multiparous mothers increased by 1.2 percentage points (0.8 to 1.6) from 39.7% to 40.9%, and decreased by 3.0 percentage points (−3.5 to −2.5) among nulliparous mothers from 39.6% to 36.6%.ConclusionsSince its announcement in October 2015, the universal two child policy has been associated with a rise in births in China and with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. No evidence of concurrent worsening outcomes (that is, premature births) was seen.

Second-child Policy and Incidence of Infant Eye Diseases in China

“…However, the prevalence of ophthalmic diseases in a second child was 90%, and in third children, it was 100%, suggesting that, for the same adult individual, a greater childbearing age might not only be associated with a higher risk of disease during pregnancy and abnormal fertility, but the chance of eventually having abnormal children is also increased. Preterm birth was found to be related to whether children suffered from ophthalmic diseases, but in a large-sample study of Li HT, the increase in the number of older mothers was not found to be related to preterm birth [1]. Liu Y's research also showed the rate of preterm birth and birth weight of the second children was not affected, perhaps due to the increase in the overall quality of medical care provided in the country [2].…”

Preterm Morbidity and Mortality by Gestational Age. A Birth Population-Based Study

“…Despite the majority of neonatal deaths attributed to preterm birth complication, and a large amount of hospital admission-based data by gestational age (GA) available in China, the whole picture of perinatal-neonatal care remains unclear due to a lack of birth population-based clinical surveys [6][7][8][9]. Although the number of Chinese annual birth population has reached 15-17 million in the past decade, with an established universal health insurance covering maternal-infant healthcare [10][11][12][13], there is a paucity of data on vital statistics of preterm births and assessment of combined effects of antenatal, peripartum and postnatal interventions on perinatal and neonatal outcome in the preterm birth and hospitalized population.…”

“…The current study aimed to depict the morbidity and mortality of whole regional preterm births and hospitalized infants strati ed by GA, investigate the role of Huai'an Women and Children's Hospital (HWCH) as the main transferal center of whole region, and verify the e cacy of perinatal interventions and the underlying neonatal morbidities of deaths. As birth population-based studies on perinatal and neonatal healthcare are still at preliminary stage in China [6,12,13], our concept and methodology of using regional birth registry data to assess death risks in hospitalized preterm population and the quality of regional perinatal-neonatal healthcare system may be helpful to re-evaluate and optimize the standard of care and health insurance policy in the transitional period of China [6,13].…”

Incidence, risk factors, and causes of maternal near-miss admitted to the intensive care unit in Yangzhou, China: A 5-year retrospective study

“…After the implementation of the universal twochild policy in 2016, experts predict that the number of births will increase signi cantly in the next ve years [11],which was estimated from 100,000 to more than 10 million each year [12]. The change in demographic structure will not only increase the number of older women, but also heighten the risk of pregnancy and the incidence of pregnant complications and comorbidities [12,13].Obstetricians are facing greater challenges. The joint management of MNM by obstetrics and the intensive care unit (ICU) is a major measure for the rescue of emergency obstetrics.…”