Assessing intentions for a third child among Chinese adults: A nationwide online survey regarding China's 3-child policy.

Aging populations, along with low fertility rates, have become a pervasive world-wide problem. To address this challenge, China issued a universal 3-child policy on May 31, 2021. However, little is known regarding the intentions of childbearing-aged Chinese for a third child. The purpose of this study was to assess the fertility intentions of the Chinese as related to this third-child policy and identify risk factors for third-child refusal. In this cross-sectional study, a total of 2129 Chinese childbearing-aged participants were recruited nationwide from June 15 to July 22, 2021. Each participant was interviewed using questionnaires to establish their sociodemographic variables, psychosocial factors as related to third-child intentions, and reasons for third-child refusal. Finally, 2115 responses (866 men and 1249 women) were analyzed. IBM SPSS Statistical Software (version 19) was used for the statistical analyses. Multivariate logistic regression analyses were used to assess independent influences for third-child refusal. Approximately 30% of these participants reported an intention for having a third child. In those expressing a refusal for a third child, women showed a higher prevalence rate (74.1 vs 63.2%, P < .001). Results from multivariate logistic regression analyses revealed that age (P = .033), unemployment (P = .045), and currently raising 2 children (P = .017) were risk factors for third-child refusal among men, while age (P < .001), >15 years of education (P = .017), current smokers (P = .005) and residing in Northern China (P = .035) were risk factors for women. Overall, increased demands upon time and energy (41.5%), as well as economic burdens (41.4%), were the most prevalent reasons for the refusal of a third child, while achieving mutual care among siblings (52.5%) and reducing child educational costs (33.3%) were the most effective persuasions. In response to the 3-child policy, Chinese childbearing-aged adults showed low rates of intention for a third child, with women showing a higher prevalence of third-child refusal. The identification of risk factors and the reasons for third-child refusal as revealed from the results of this study provide a foundation for the development of programs needed to aid in the implementation of this 3-child policy.

Yue C ，Zheng X ，Shang W ，Wang P ，Xie Z ，Luo L ，Xu Y ，Li Q ，Song D ，Yue X ，Wang X ，Yuan X ，Cao Y ... -  《-》

Fertility intentions to have a second or third child under China's three-child policy: a national cross-sectional study.

What proportion of people want to have a second or third child after the enactment of the three-child policy in China? Under the three-child policy, fertility intention to have a second child was ∼60% (56% of women vs 65% of men), and fertility intention to have a third child was 13% (10% of women vs 17% of men) among the Chinese population. The Chinese government announced the three-child policy on 31 May 2021, allowing all couples to have up to three children. At present, there is a lack of national surveys on the fertility intentions of women and men to have a second or third child under the three-child policy in China. In June 2021, a national cross-sectional survey including 9243 respondents aged 18-49 years was conducted online from 31 provinces in China's mainland using a random sampling method. Data on the intention to have a second or third child were collected by anonymous questionnaire. Descriptive statistics were performed to assess fertility intentions. Multivariate and multinomial logistic regression analyses were used to assess the association between fertility intentions and the investigated factors. Approximately 60% (5493/9243) of the investigated people (55.6% women vs 64.7% men) intended to have a second child, and 13.0% (1203/9243) of them (10.0% women vs 17.1% men) intended to have a third child under China's three-child policy. For non-child respondents, 46.8% of women and 60.4% of men intended to have a second child. For one-child respondents, 47.8% of women and 53.8% of men intended to have a second child. For two-child respondents, 14.4% of women and 25.9% of men intended to have a third child. The mean desired family size was 1.58 children per woman, which was lower than the 1.76 children per man. Notably, the age-specified fertility intentions of men were always higher than those of women. Women with a college or higher degree (adjusted odds ratio [aOR] 0.60, 95% CI 0.42-0.88) and a high-middle (aOR 0.71, 95% CI 0.53-0.95) or high (aOR 0.64, 95% CI 0.48-0.85) household income, as well as men living in urban areas (aOR 0.71, 95% CI 0.58-0.87) and having a high-middle household income (aOR 0.68, 95% CI 0.52-0.90), were associated with a lower intention to have a third child (all P < 0.05). In contrast, men of public service personnel had a higher intention to have a third child than factory workers (aOR 1.44, 95% CI 1.02-2.04, P < 0.05). Meanwhile, approximately one out of five two-child respondents intended to have a third child, while one out of four two-girl respondents (aOR 2.09, 95% CI 1.44-3.04) were willing to have a third child with a strong preference for boys (12.7% for boys vs 2.7% for girls). Economic and childrearing barriers were the leading barriers to having one more child. The online survey might limit the representativeness of the present study's sample. A large sample size was enrolled and a random sampling method was used to increase the sample diversity and representativeness. This study will assist in estimating the impact on population demographic of the three-child policy in China. Multiple efforts are needed to create a fertility-friendly environment for couples, thereby increasing fertility intentions to have one more child and increasing fertility rates. No funding. The authors declare no conflict of interest. N/A.

Jing W ，Liu J ，Ma Q ，Zhang S ，Li Y ，Liu M ... -  《-》

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.

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. 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. 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. 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.

Chen Q ，Wang A ，Song X ，Liu X ，Liu Y ，Wei J ，Shu J ，Sun M ，Zhong T ，Luo M ，Wang T ，Zhang S ，Xie D ，Qin J ... -  《-》

Third birth intention of the childbearing-age population in mainland China and sociodemographic differences: a cross-sectional survey.

Global fertility declines have become an inevitable trend, and many countries are adopting policies to drive fertility increases. Fertility intention plays an important role in predicting fertility behavior. The Chinese government has recently issued the 'three-child' policy, and there is still little research on the third birth intention of the childbearing-age population. Therefore, the aim of this study is to investigate the prevalence and related reasons of third birth intention in the childbearing-age population in mainland China, and analyze the sociodemographic differences. A cross-sectional survey was conducted in mainland China from June to July 2021. A total of 15,332 childbearing-age participants responded and completed the Fertility Intention Questionnaire online through the Wenjuanxing Platform. Data were explored and analyzed by SPSS (version 22.0) software. Descriptive statistics were used to describe the current situation and reasons of third birth intention. Binary logistic regression analysis was applied to assess the influencing factors in the sociodemographic level. The mean age of the participants was 32.9 ± 5.94 years. Only 12.2% of participants reported having third birth intention. The subjective norm of having both son and daughter (22.0%) and busy at work (29.2%) accounted for the largest proportion in the reasons of acceptance and rejection, respectively. Age has negative impact on third birth intention (OR = 0.960). Men were 2.209 times more likely to have three children than women (P < 0.001). With the improvement of education and family monthly income, the birth intention shows a downward trend. Compared with Han nationalities, first marriage and city residents, the ethnic minorities, remarriage and rural residents have stronger birth intention (all P < 0.05). And individuals with two existing children are inclined to have the third child (OR = 1.839). The third birth intention in the childbearing-age population in China is still low after the announcement of the three-child policy. It is necessary to create a favorable fertility context for childbearing-age group with high level of third birth intention, like younger, male, minority, remarriage, with lower education and family monthly income, living in rural and two existing children. Furthermore, removing barriers for those unintended is also prominent to ensure the impetus of policy.

Yan Z ，Hui L ，Wenbin J ，Liuxue L ，Yuemei L ，Bohan L ，Lili W ... -  《BMC PUBLIC HEALTH》

Changes in fertility intention among married Chinese couples with two children during COVID-19: a cross-sectional study.

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. To describe married couples' changes in intention to have a third child during the COVID-19 pandemic and determine factors associated with altered intentions. 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. 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. 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.

Ning N ，Tan X ，Li Y ，Tang J ，Lommel L ，Sun M ... -  《-》