Lau Bobo Hi-Po, Huo Ran, Wang Kun, Shi Li, Li Rong, Mu Sha, Peng Hongmei, Wang Yu, Chen Xiujuan, Ng Ernest Hung-Yu, Chan Celia Hoi-Yan
Department of Social Work and Social Administration, University of Hong Kong, Hong Kong.
Department of Obstetrics & Gynaecology, University of Hong Kong-Shenzhen Hospital, Futian, Shenzhen, China.
Hum Reprod Open. 2018 Sep 25;2018(4):hoy014. doi: 10.1093/hropen/hoy014. eCollection 2018.
What is the intention to have a second child among women attending outpatient gynecology clinics in three major cities in China?
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.
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.
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.
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; < 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.
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 was therefore unavailable.
With the introduction of the universal two-child policy, there is a need to enhance fertility awareness and to encourage reproductive life planning, as well as to lower the cost of childcare, in order to increase the birth rate in China. Effort is required to make childbearing more compatible with current employment, career and educational development, the burdens of family care (e.g. for elderly parents), social environments and cultural expectations. This is particularly relevant for families who already have a child, as our findings show that their hesitation toward a second child was largely related to difficulties with extra childcare within the woman's current work and family life.
STUDY FUNDING/COMPETING INTERESTS: This study did not receive any funding. The authors declared no competing interests.
Not applicable.
在中国三大城市的妇科门诊就诊的女性中，生育第二个孩子的意愿如何？
总体而言，69.3%的参与者表示有生育第二个孩子的意愿，这与不孕状况、生育意愿态度和社会人口学因素有关。
2016年，中国出台了新的普遍二孩政策，使所有中国夫妇都能生育第二个孩子。一项由政府主导的全国性调查显示，该政策涵盖的大多数女性年龄将在35岁及以上，因此不孕风险更高。此前的研究发现，生育意愿因不孕状况而异。
研究设计、规模、持续时间：进行了一项横断面调查，以研究中国三大城市妇科门诊中不孕和有生育能力的女性生育第二个孩子的意愿及其相关因素。临床护士在女性等待咨询时亲自接触符合条件的女性。招募和数据收集于2016年4月至8月进行。
参与者/材料、环境、方法：该调查涉及北京、深圳和呼和浩特的四家妇科门诊。邀请年龄在20-45岁、因非恶性问题寻求妇科门诊护理的已婚女性参与。
974名女性的数据纳入了分析。共有69.3%的女性表示有生育第二个孩子的意愿，与有生育能力的女性相比，不孕女性更有可能想要第二个孩子（分别为76.6%和61.9%；P<0.001）。更高的理想子女数促进了两组女性生育第二个孩子的意愿，而生育意愿态度（即她们更倾向于在年轻时生育第一个孩子，并更重视传统生育观念）、不明原因的不孕、有存活子女以及宗教信仰与不孕女性更强的生育意愿相关。相比之下，在有生育能力的女性组中，年龄较大、全职工作以及对实现理想子女数目标的信心较低会降低生育第二个孩子的意愿。尽管不孕女性对生育意愿态度的认同度更高，且期望有更高的理想子女数，但与有生育能力的女性相比，她们对实现理想子女数目标的信心较低。
局限性、谨慎的理由：除了自我报告和自我选择偏差外，我们的参与者来自城市化地区，且受教育程度高于普通人群。由于诊所环境极其繁忙，在记录护士接触的女性人数方面遇到了困难，因此无法获得应答率。
随着普遍二孩政策的出台，有必要提高生育意识，鼓励生育生活规划，并降低育儿成本，以提高中国的出生率。需要努力使生育与当前的就业、职业和教育发展、家庭护理负担（如照顾老年父母）、社会环境和文化期望更加协调。这对于已经有一个孩子的家庭尤为重要，因为我们的研究结果表明，他们对生育第二个孩子的犹豫很大程度上与女性当前工作和家庭生活中额外育儿的困难有关。
研究资金/利益冲突：本研究未获得任何资金。作者声明无利益冲突。
不适用。
