Abstract
BackgroundThe One-Child Policy led to the imbalance of the sex ratio at birth (SRB) in China. After that, Two-Child Policy was introduced and gradually liberalized at three stages. If both the husband and wife of one couple were the only child of their parents, they were allowed to have two children in policy (BTCP). If only one of them was the only child, they were allowed to have two children in policy (OTCP). The Universal Two-Child Policy (UTCP) allowed every couple to have two children. The objective of this study was to explore the changing trend of SRB at the stages of Two-Child Policy, to analyze the effect of population policy on SRB in terms of maternal age, delivery mode, parity, maternal education, delivery hospital, and to figure out what factors have greater impact on the SRB.MethodsThe data of the study came from Hebei Province Maternal Near Miss Surveillance System, covered the parturients delivered at 28 gestation weeks or more in 22 hospitals from January 1, 2013 to December 31, 2017. We compared the SRB at different policy stages, analyzed the relationship between the SRB and population policy by logistic regression analysis.ResultsTotal 270,878 singleton deliveries were analyzed. The SRB, 1.084 at BTCP, 1.050 at OTCP, 1.047 at UTCP, declined rapidly (χ2 = 15.97, P < 0.01). With the introduction of Two-Child Policy, the percentage of parturients who were 30–34, ≥35 years old rose significantly, and the percentage of multiparous women increased significantly (40.7, 47.2, 56.6%). The neonatal mortality declined significantly (8.4‰, 6.7‰, 5.9‰, χ2 = 44.49, P < 0.01), the mortality rate of female infant gradually declined (48.2, 43.7, 43.9%). The logistic regression analysis showed the SRB was correlated to the three population policy stages in terms of maternal age, delivery mode, parity, maternal education, delivery hospital.ConclusionsThe SRB has declined to normal level with the gradually liberalizing of Two-Child Policy in China. Advanced maternal age, cesarean delivery, multiparous women, middle level education, rural hospital are the main factors of effect on the decline of the SRB.
Highlights
The One-Child Policy led to the imbalance of the sex ratio at birth (SRB) in China
The SRB of dead neonatal babies increased significantly at different stages, the percentage of the death of the female babies was 48.2% at BTCP stage, and it decreased to 43.7% at OTCP stage, and 43.9% at Universal Two-Child Policy (UTCP) stage, this showed that the proportion of death of female babies has gradually declined (F = 30.83, P < 0.01)
BTCP: Both the husband and wife of one couple were the only child of their parents, the couple were allowed to have Two Children in Policy (January 1, 2013 - May 29, 2014); OTCP: Only the husband or wife of one couple was the only child of their parents, the couple were allowed to have Two Children in Policy (May 30, 2014 - December 31, 2015); UTCP: the Universal Two-Child Policy, every couple were allowed to have two children
Summary
The One-Child Policy led to the imbalance of the sex ratio at birth (SRB) in China. In order to control the population growth rate and reduce the fertility rate, Chinese government implemented the One-Child Policy since 1979, a couple was allowed to have only one child [1]. The Chinese government has taken various policies and measures to reduce the SRB, for example, by providing equal work opportunities for men and women, allowing couples in rural areas to have the second child if their first child is a girl, and strictly prohibiting prenatal sex selection, but the SRB remains skewed [2, 3, 19]. Is there any relationship between SRB and Two-Child Policy of China?
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