Implementation Of Two-child Policy Research Articles

Firstborn children’s sex specific emotions and behaviors during mothers’ second pregnancy after implementation of the universal two-child policy in China

The present cross-sectional study aimed to identify sex-specific characteristics and other factors for firstborn children’s emotions and behaviors during their mothers’ second pregnancy after the implementation of the two-child policy in China. Firstborn children aged 1.5–5 years old and their pregnant mothers were enrolled from two hospitals from March to September 2019 in our city. Mothers completed a self-designed questionnaire and Child Behavior Checklist during their routine prenatal examinations. Linear regression was used to explore potential factors influencing firstborn children’s behaviors and emotions towards their mother’s second pregnancy. A total of 880 firstborn children were included. There was no significant difference in internalizing/externalizing problem scores and prevalence between male and female firstborn children during their mothers’ second pregnancy. Children’s easy temperament, good parental relationship, and father’s authoritative and indulgent parenting styles were potential positive factors for both male and female firstborn children. Harmonious family environment, children’s age, father's accompaniment, and being informed by parents of the arrival of a sibling were only related to firstborn girls experiencing fewer emotional and behavioral problems. Mother’s education and seeking for firstborn children’s opinion about the new sibling were only related to firstborn boys experiencing fewer emotional and behavioral problems. There was no sex differences in internalizing/externalizing problems in firstborn children during their mother’s second pregnancy. Children’s temperament, family environment and fathers’ parenting styles were consistent influencing factors for both firstborn girls’ and boys’ emotions and behaviors.

Changes in cesarean delivery rate and indications against the background of two-child policy

Objective To study the changes in cesarean delivery rate (CSR) and indications against the background of two-child policy. Methods Maternal information and indications for cesarean delivery were retrospectively obtained from medical records of 62 007 women who delivered at the Obstetrics and Gynecology Hospital of Fudan University between January 2013 and December 2016. Indications for cesarean section were divided into 16 categories, such as maternal or fetal indication, repeat cesarean section, maternal request, labor arrest disorders, fetal distress, and so on. Changes in CSR and the proportion of cesarean delivery for each indication were evaluated. One-way analysis of variance, Chi-square or Fisher's exact test were used for statistical analysis. The average annual percent change (AAPC) in cesarean delivery rate was calculated by Joinpoint Analyses software. Relative contribution of each indication to the overall increase or decrease in CSR was analyzed using the data of the years of 2013 and 2016. Results The CSR dropped from 45.2% (6 683/14 798) in 2013 to 38.3% (6 546/17 104) in 2016. The rate of cesarean delivery due to maternal request and labor arrest disorders decreased significantly (χ2=49.402 and 14.617, both P<0.05) .The rate of cesarean delivery due to labor arrest disorders in all cases decreased sharply from 14.7‰ in 2013 to 0.9‰ in 2016 at an annual decrease of 48.0% (95%CI: -67.6%--21.5%). It was also worth noting that the rate of cesarean delivery on maternal request in all cases decreased from 119.3‰ in 2013 to 40.7‰ in 2016 at an average annual decrease of 30.1% (95%CI: -31.3%--28.9%). Despite of a limited number of cesarean delivery cases for uterine scar caused by leiomyoma resection, its rate increased from 1.4 per 1 000 deliveries in 2013 to 2.9 per 1 000 deliveries in 2016 with the highest average annual increase of 32.3% (95%CI: 10.1%-60.9%), followed by the rate of cesarean delivery due to maternal pyrexia, increasing from 6.6 per 1 000 deliveries in 2013 to 16.4 per 1 000 deliveries in 2016 at an average annual increase of 27.4% (95%CI: 11.0%-46.5%), and the rate of cesarean delivery due to repeat cesarean section, increasing from 67.6 per 1 000 deliveries in 2013 to 113.9 per 1 000 deliveries in 2016 at an average annual increase of 19.0% (95%CI: 5.0%-34.6%). The first two positive contributors to the total decrease of CSR were maternal request and labor arrest disorders (144.2% and 27.7%, respectively), while the first two negative contributors were repeat cesarean section and maternal pyrexia (-102.3% and -18.9%, respectively). Conclusions The CSR is reduced after the implementation of two-child policy through active control on maternal request and application of new partogram. Key words: Cesarean section; Cesarean section, repeat; Social control policies