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

Abstract

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 wa...

Fertility intentions among couples in Shanghai under COVID‐19: A cross‐sectional study

“…1 As a systemic problem, fertility intentions are influenced by many factors including the economy, fertility policies, level of education, the environment, and public services. 2 Despite the implementation of the two-child policy in 2015, the total number of annual births in China has not shown a clear trend of growth. According to the China Health Statistics Yearbooks of 2018 and 2019, the number of live births by pregnant women in China dropped from 18.47 million in 2016 to 17.58 million in 2017, and then fell to 13.62 million in 2018.…”

“…Fertility intention is the expression of fertility desire based on an individual or family preference for children, taking into account various limitations such as the ideal number of children, gender, time, and interval of pregnancy 1 . As a systemic problem, fertility intentions are influenced by many factors including the economy, fertility policies, level of education, the environment, and public services 2 …”

Intent to have a second child among Chinese women of childbearing age following China’s new universal two-child policy: a cross-sectional study

“…However, only 1.45 million (13.2%) of the 11 million eligible couples applied for permission to have a second child by May 2015 1 4. Fertility intent is regarded as a predictor of fertility behaviour;5 and in addition to policy, intent to procreate is also influenced by individual, social, economic and cultural factors 4 6. Several investigators have reported on the intent to have a second child in China (which varies from 13.2% to 69.3%) and its associated factors, including age, occupation, educational level, and gender of the first child 4–8.…”

“…Fertility intent is regarded as a predictor of fertility behaviour;5 and in addition to policy, intent to procreate is also influenced by individual, social, economic and cultural factors 4 6. Several investigators have reported on the intent to have a second child in China (which varies from 13.2% to 69.3%) and its associated factors, including age, occupation, educational level, and gender of the first child 4–8. However, these studies were principally conducted in particular populations or settings, such as a rural population, women attending outpatient gynaecology clinics, or women from one specific province.…”

Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study

“…Second, women’s fertility is strongly linked to age. Women aged 35 years or older have significant uncertainty in their diminished reproductive potential,26 and may be more sensitive to the narrowing chance of childbearing. According to the theory of planned behaviour, a positive belief and attitude toward one thing would promote the intention to take action 27.…”