Dong Wen-Hong, Wang Xia, Yuan Fan, Wang Lei, Gu Tian-Miao, Zhu Bing-Quan, Shao Jie
Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Department of Child Health Care, Zhejiang Maternal, Child and Reproductive Health Care Center, Hangzhou, China.
Hum Reprod Open. 2024 Sep 17;2024(4):hoae055. doi: 10.1093/hropen/hoae055. eCollection 2024.
How many couples with at least one child under 3 years would like to have another one or more child(ren) in Eastern China and will an in-cash subsidy be conducive to couple's fertility intentions?
In sum, only 15.1% of respondents had further fertility intentions (FFI) before learning about the subsidy, and the planned in-cash subsidy policy increased respondents' overall FFI by 8.5%.
Fertility has been declining globally and has reached a new low in China. The reasons why the Chinese three-child policy was under-realized, and how couples will react to a planned monthly ¥1000 (€141.2) subsidy policy, are not fully understood.
During January and February 2022, a cross-sectional online survey aiming to understand families' expenses of raising a child under 3 years old, and couples' FFI, was conducted. During the survey period, 272 510 respondents scanned the QR code. This study reports the findings pertaining to questions on respondents' sociodemographic characteristics, household factors, FFI, and changes in intention from negative to positive after learning about the planned in-cash subsidy. After exclusion, 144 893 eligible responses were included.
PARTICIPANTS/MATERIALS SETTING METHODS: Respondents' FFI, the effect of a planned ¥1000/month*36 months' in-cash subsidy (€5083.2 in total) on people with a negative FFI before the subsidy, and potential reasons for persistent negative FFI after learning about the subsidy were collected through an anonymous online survey. Stepwise binary logistic regression models were used to select associated factors. The potential fertility rate change and government costs were estimated. A stratified analysis by current child number and sensitivity analysis were also conducted.
In sum, 15.7% (22 804/144 893) of respondents were male, 15.1% of respondents reported a positive FFI, and 10.0% (12 288/123 051) without an FFI at first changed their intention after learning about the planned in-cash subsidy policy. For those who still said 'no FFI', 46.5%, 20.6%, and 14.7% chose pressure on housing status, expenses on children's education, and lack of time or energy for caring for another child as their first reasons. FFI was strongest in participants receiving the most financial support from their parents, i.e. grandparents (OR = 1.73, 95% CI = 1.63-1.84 for the >¥100 000/year group), and weakest in those already having two children (OR = 0.23, 95% CI = 0.22-0.24). For those with no FFI before learning about the subsidy policy, respondents with the highest house loan/rent (>¥120 000/year, OR = 1.27, 95% CI = 1.18-1.36) were more likely to change their FFI from 'No' to 'Yes', and those with the highest household income (>¥300 000/year, OR = 0.65, 95% CI = 0.60-0.71) were least susceptible to the policy. In our study population, about 1843 more births every year and an additional 0.3 children per woman were projected under a conservative estimation. Annual estimated cost at the provincial scale would be ¥817.7 (€115.5) million, about 1.02‰ of the total General Public Budget Revenue in 2022. The findings were generally robust in the stratified analysis and sensitivity analysis.
Selection bias and information errors may exist in the online survey responses. The large sample size and detailed further analysis were used to minimize such biases.
Fertility intentions in Eastern China are rather low. Policymakers should focus more on financial and childcare burdens for a better realization of the three-child policy, including housing, education and childcare services. An in-cash subsidy, which has never been used in China previously, shows promising potential for increasing FFI. However, the application of such policy should be in line with local conditions for better cost-effectiveness regarding fertility-boosting and fiscal sustainability for the government in the long run.
STUDY FUNDING/COMPETING INTERESTS: This work was supported by the National Key Research and Development Plan of China (2019YFC0840702). The authors declare no conflict of interests.
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在中国东部地区，有至少一个3岁以下孩子的夫妻中有多少人想要再生育一个或多个孩子，现金补贴是否有助于提高夫妻的生育意愿？
总体而言，在了解补贴政策之前，只有15.1%的受访者有进一步生育意愿（FFI），而计划实施的现金补贴政策使受访者的总体FFI提高了8.5%。
全球生育率一直在下降，中国已降至新低。中国三孩政策实施效果不佳的原因，以及夫妻对每月1000元（141.2欧元）补贴政策的反应，目前尚不完全清楚。
2022年1月至2月，开展了一项横断面在线调查，旨在了解家庭抚养3岁以下孩子的费用以及夫妻的FFI。调查期间，272510名受访者扫描了二维码。本研究报告了与受访者社会人口学特征、家庭因素、FFI以及了解计划现金补贴后意愿从消极转为积极相关问题的调查结果。排除无效数据后，纳入了144893份有效回复。
参与者/材料设置方法：通过匿名在线调查收集受访者的FFI、计划实施的每月1000元×36个月的现金补贴（总计5083.2欧元）对补贴前FFI为消极的人群的影响，以及了解补贴政策后仍保持消极FFI的潜在原因。采用逐步二元逻辑回归模型选择相关因素。估计了潜在生育率变化和政府成本。还按现有子女数量进行了分层分析和敏感性分析。
总体而言，15.7%（22804/144893）的受访者为男性，15.1%的受访者报告有积极的FFI，10.0%（12288/123051）起初没有FFI的受访者在了解计划现金补贴政策后改变了意愿。对于那些仍表示“没有FFI”的人，46.5%、20.6%和14.7%分别选择住房压力、子女教育费用以及缺乏照顾另一个孩子的时间或精力作为首要原因。在从父母（即祖父母）获得最多经济支持的参与者中，FFI最强（年收入超过10万元组的OR = 1.73，95%CI = 1.63 - 1.84），而在已有两个孩子的参与者中最弱（OR = 0.23，95%CI = 0.22 - 0.24）。对于补贴政策出台前没有FFI的人，房贷/房租最高的受访者（年收入超过12万元，OR = 1.27，95%CI = 1.18 - 1.36）更有可能将FFI从“否”改为“是”，而家庭收入最高的受访者（年收入超过30万元，OR = 0.65, 95%CI = 0.60 - 0.71）对该政策最不敏感。在我们的研究人群中，保守估计每年约增加1843例出生，每名女性额外增加0.3个孩子。省级层面的年度估计成本为8.177亿元（1.155亿欧元），约占2022年一般公共预算收入总额的1.02‰。分层分析和敏感性分析的结果总体上较为稳健。
在线调查回复中可能存在选择偏差和信息错误。本研究采用大样本量和详细的进一步分析以尽量减少此类偏差。
中国东部地区的生育意愿相当低。政策制定者应更多关注经济和育儿负担，以更好地落实三孩政策，包括住房、教育和托儿服务。此前在中国从未使用过的现金补贴，在提高FFI方面显示出有希望的潜力。然而，此类政策的应用应因地制宜，以在长期提高生育率和政府财政可持续性方面实现更好的成本效益。
研究资金/利益冲突：本研究得到中国国家重点研发计划（2019YFC0840702）的支持。作者声明无利益冲突。
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