Intention of having a second child among infertile and non-infertile women attending outpatient gynecologic clinic in three major cities of China: A cross sectional study

Abstract

Study question: What is the intention to have a second child among women attending outpatient gynecologic clinics in three major cities (Beijing, Shenzhen, Hohhot) in China? Summary answer: 69.3% participants expressed the intention to have a second child. Second-child intention was related to infertility status, pro-natalist attitudes and socio-demographic factors. What is known and what this paper adds: In 2016, the new universal two-child policy was introduced in China enabling all Chinese couples to entitle a second child. This study examined the intention of having a second child and its associated factors among infertile and non-infertile women attending gynecology out-patient clinics in three major cities in China. Design: Cross-sectional survey Participants and setting: The survey involved four gynecology out-patient clinics in Beijing, Shenzhen, and Hohhot. Married women aged 20-45 years who were seeking outpatient gynecologic care for non-malignant problems were recruited. Main results and the role of chance: Data from 974 women were included in the analysis. 69.3% women expressed an intention to have a second child and infertile women more likely wanted a second child than non-infertile women (76.6% vs 61.9%; p<0.001). While greater ideal parity facilitated the second child intention in both groups, pro-natalist attitudes, unexplained infertility, presence of a living child, and religious affiliation were associated with a greater intention among infertile women, whereas higher age, full-time occupation, and lower confidence in achieving parity goals diminished the second child intention in the non-infertile group. Although infertile women displayed greater agreement with pro-natalist attitudes and desired a higher ideal parity, they have less confidence in achieving their parity goals than their non-infertile counterparts. Statistical significance is indicated with p-value of less than 0.05. Bias, confounding factors and other reasons for caution: In addition to self-report and self-selection bias, our participants were recruited from urbanized areas and are more educated than the general population. We met enormous logistical difficulties in tracking women who refused to participate in the study, therefore the response rate was unavailable. Generalizability to other populations: Our findings illustrate the expectations toward a second child among women attending outpatient gynecologic services in China. Despite the introduction of the universal two-child policy, there is a need to enhance fertility awareness and encourage reproductive life planning as well as lower the cost of childcare in order to increase childbirths in China.