How does the two-child policy affect the sex ratio at birth in China? A cross-sectional study

Abstract

Background The One-Child Policy led to the imbalance of the sex ratio at birth (SRB) in China. After that, Two-Child Policy was introduced and gradually liberalized at three stages. If both the husband and wife of one couple were the only child of their parents, they were allowed to have two children in policy (BTCP). If only one of them was the only child, they were allowed to have two children in policy (OTCP). The Universal Two-Child Policy (UTCP) allowed every couple to have two children. The objective of this study was to explore the changing trend of SRB at the stages of Two-Child Policy, to analyze the effect of population policy on SRB in terms of maternal age, delivery mode, parity, maternal education, delivery hospital, and to figure out what factors have greater impact on the SRB. Methods The data of the study came from Hebei Province Maternal Near Miss Surveillance System, covered the parturients delivered at 28 gestation weeks or more in 22 hospitals from January 1, 2013 to December 31, 2017. We compared the SRB at different policy stages, analyzed the relationship between the SRB and population policy by logistic regression analysis. Results Total 270,878 singleton deliveries were analyzed. The SRB, 1.084 at BTCP, 1.050 at OTCP, 1.047 at UTCP, declined rapidly (χ2 = 15.97, P < 0.01). With the introduction of Two-Child Policy, the percentage of parturients who were 30–34, ≥35 years old rose significantly, and the percentage of multiparous women increased significantly (40.7, 47.2, 56.6%). The neonatal mortality declined significantly (8.4‰, 6.7‰, 5.9‰, χ2 = 44.49, P < 0.01), the mortality rate of female infant gradually declined (48.2, 43.7, 43.9%). The logistic regression analysis showed the SRB was correlated to the three population policy stages in terms of maternal age, delivery mode, parity, maternal education, delivery hospital. Conclusions The SRB has declined to normal level with the gradually liberalizing of Two-Child Policy in China. Advanced maternal age, cesarean delivery, multiparous women, middle level education, rural hospital are the main factors of effect on the decline of the SRB.

Recent sex ratio at birth in China

“…A universal decline can be observed over the years. With the universal two-child policy, the SRB has declined and approached the normal level, 46 but the difference by fertility policy area still existed.…”

COVID-19 Knowledge and Pandemic-Associated Distress Among the Hospital Pharmacist Workforce in China

“…In China, pharmacists aged from 31 to 50 comprise the backbone of the department, and there was a higher demand for their professional knowledge. In addition, due to China's gradually open two child policy, the percentage of multiparous mothers and parturients who were≥30 years old rose significantly 21 , a considerable number of people in this age group have children at home, usually young children or infants, which are vulnerable to infection 22 , so there was a positive need for protection. In the designated hospital for treatment of COVID-19 patients, the drug supply center and inpatient pharmacy needed to know the information of therapeutic drugs for COVID-19 in advance to ensure the drug supply.…”

Early-term birth and its association with universal two-child policy: a national cross-sectional study in China

“…However, the relationship between universal two-child policy and newborn outcomes births is still unclear. Studies have reported that the change of the birth control policy might result in nationwide changes to a range of health outcomes, such as a more equal sex ratio, reduced neonatal mortality, 13 and increased risk of birth defects. 14 However, the new two-child policy might also be associated with outcomes related to birth term.…”

“…Furthermore, studies showed that the relationship of universal two-child policy with obstetric issues can vary across different maternal characteristics. 13 16 24 For example, it has been reported that the associations between the two-child policy and sex ratios differed by maternal age, parity, and history of C-section. 13 It has also been found that the association of two-child policy with caesarean birth rate varies between nulliparous and multiparous women.…”

“… 13 16 24 For example, it has been reported that the associations between the two-child policy and sex ratios differed by maternal age, parity, and history of C-section. 13 It has also been found that the association of two-child policy with caesarean birth rate varies between nulliparous and multiparous women. 24 Moreover, the risk of childbearing policy on incidence of birth defects has been found to be higher in women aged 30–34 years old when compared with their younger counterparts.…”