Implementation Of Universal Two-child Policy Research Articles

How Does Fertility Policy Relaxation Affect Household Financial Asset Allocation? Evidence from the Universal Two-Child Policy in China

Both fertility policy and the healthy development of financial markets are important topics for sustainable economic and social development. By using the difference-in-difference (DID) model, this paper investigates how the universal two-child policy (UTCP) in China aiming to improve fertility affects household financial asset allocation, based on the China Family Panel Studies (CFPS) data from 2010 to 2018. The results show that the implementation of UTCP has a significant negative impact on household risk asset holdings. Specifically, the policy decreases the probability of households participating in the financial market by 3.1 percentage points, reduces the total value of risk assets held by 50.2%, and lowers the proportion of risk asset investment by 1.76 percentage points. Mechanism analysis suggests that the implementation of the policy has a significantly negative impact on labor market outcomes for women, which decreases household income and increases the time and effort spent on caring for children. As a result, the financial resources available for household financial asset investment are diminished, and the time for activities such as information gathering and financial asset transactions is squeezed out, ultimately leading to a decrease in household risk asset investment. Heterogeneity analysis reveals that households with self-employed wives (higher income instability), households without a co-resident status with grandparents (more time spent on childcare), and high-income households (stronger willingness to have more children) are more affected by the policy. This study provides new supplements on how fertility policies affect the allocation of household financial assets and proposes constructive suggestions on how to establish a comprehensive system of childcare welfare and alleviate the economic pressure of family childcare in developing countries.

Early Term Birth in China and its Association with Universal Two-Child Birth Policy

Background: Early term births (ETB) are related to the morbidity and mortality of infants, and its incidences have not been reported in China. In this study, we aimed to describe the epidemiology of ETB at the national and provincial level, and explore its changes after the implementation of universal two-child policy owing to the timing of policy’s initiation across the research period. Methods: This national multicenter cross-sectional study (n = 75132) used the China Labor and Delivery Survey data collected from 89 hospitals in 25 (out of 34) provinces of mainland China between March 1st 2015 and December 31st 2016. A total of 28,966 low-risk singleton live birth records were included in the analysis of association between universal two-child policy and ETB using a multi-level Poisson regression of sandwich estimation. Findings: The weighted incidence of ETB was 30.1 per 100 all births (95% CI =30.06%, 30.14%) or 29.88 per 100 live births (95% CI = 29.97%, 30.05%) in China. The incidences of ETB were varied by maternal age, parity and previous uterine scars. We found that there were associations between universal two-child policy and ETB when not adjusting for (RR=1.19, p 0.05). Interpretation: The incidence of ETB is high in China and demonstrated practice patterns amenable to improvement. Great importance should be attached to preventing ETB, which risk being more likely after the implementation of the universal two-child policy, especially in young women or women without previous uterine scars. Funding Statement: This study was partly supported by National Natural Science Foundation of China (81673179), the Science and Technology Commission of Shanghai Municipality (18140903100,19140903100), the Shenkang Hospital Development Center (SHDC12016239) Declaration of Interests: We declare no competing interests. Ethics Approval Statement: This study was approved by the Ethics Committees of Xinhua Hosptial (XHECC2015-006) and World Health Organization(A65899). Since only anonymous clinical information were collected, no individual informed consent was obtained.

Prevalence of diabetes mellitus and hypertension during pregnancy in eastern China after the implementation of universal two-child policy

Few studies have assessed the prevalence of diabetes and hypertension among pregnant women in China after the implementation of universal two-child policy. Therefore, the aim of the study was to determine the prevalence of diabetes and hypertension from 2016 to 2018 among pregnant women in Jiangsu, China, after the policy implementation. We analysed data from pregnant women who delivered their neonates between 2016 and 2018 in the Northern Jiangsu People’s Hospital. All pregnant women irrespective of their gestation weeks underwent oral glucose intolerance tests in a fasting state. A total of 3262 pregnant women were included. The overall prevalence of diabetes and hypertension in pregnant women was 21.8% and 2.4%, respectively. In addition, the prevalence of low birth weight (LBW) and macrosomia for participants with diabetes was significantly higher than those without diabetes (LBW: 4.4. vs. 2.6%, p = 0.017; macrosomia: 10.1 vs. 5.8%, p < 0.001). There was a significant increasing trend in the prevalence of diabetes, which was from 18.9% in 2016 to 25.4% in 2018 (p < 0.001). Similarly, there was also a significant increasing trend in the prevalence of diabetes across the increasing age group (from 16.4% in 18–24 years to 47.6% in 40–45 years) (p < 0.001). Our study reported a high prevalence of diabetes among this sample of Chinese pregnant women. In addition, advanced maternal age was found to be a risk factor of diabetes in pregnant women. Therefore, in view of high prevalence of diabetes, screening for diabetes in pregnant women is strongly recommended, regardless of their age, BMI, and gestation weeks.

Mental health outcomes among Chinese prenatal and postpartum women after the implementation of universal two-child policy

BackgroundPoor mental health status among both pregnant and postpartum women is commonly reported worldwide. The associations between mental health outcomes and giving birth to the second child since the implementation of China's universal two-child policy have not been identified. MethodsA large-scale based mental health survey was conducted between March 2017 and December 2018 in Suzhou, China. The survey evaluated the symptoms of anxiety, hypomania, depression and poor sleep quality among both pregnant and postpartum women. ResultsA total of 3113 questionnaires were collected, the prevalence of anxiety, hypomanic and depressive symptoms and poor sleep quality in our sample were 3.2% (95%CI: 2.6%–3.9%), 51.7% (95%CI: 49.9%–53.4%), 12.4% (95%CI: 11.3%–13.6%) and 37.8% (95%CI: 36.0%–39.5%), respectively. Logistic regression showed that giving birth to the second child was positively associated with women's age, and was negatively correlated with higher educational level and living in rented housing. Women with the second pregnancy or child were positively associated with anxiety symptoms in the whole sample (OR = 1.75, 95%CI: 1.11–2.75) and among prenatal women (OR = 2.11, 95%CI: 1.16–3.83), while it was inversely correlated with depressive symptoms among postpartum women (OR = 0.63, 95%CI: 0.41–0.99). ConclusionsWomen giving birth a second time were more prone to have anxiety symptoms among the prenatal women and the whole sample, and less likely to have depressive symptoms among the postpartum women. Efficacious measures and interventions are essential to improve maternal mental health.

The relationship between vitamin D and insulin resistance before delivery in advanced maternal age

BackgroundWith the widely implementation of universal two-child policy, the number of pregnant women in advanced maternal age (AMA) will increase gradually. We aimed to assess the association of vitamin D levels and insulin resistance (IR) during the late pregnancy in AMA.MethodsA total of 80 pregnant women were consecutively enrolled in the cross-sectional study before delivery from the August 2016 to June 2017 at the department of gynecology and obstetrics in the hospital of ZhongDa, affiliated to Southeast University. At delivery, serum 25(OH) D and metabolism parameters including glucose and lipid levels were measured. IR was calculated by the method of homeostasis model assessment 2(HOMA2).ResultsPregnant women in AMA with vitamin D deficiency have higher fasting insulin (14.70(8.76–34.65) and 10.89(7.15–16.12), respectively, P = 0.031) and HOMA-IR indices (1.78(1.07–4.14) and 1.30(0.83–1.89), respectively, P = 0.024) than those with vitamin D non-deficiency. Serum 25(OH) D levels were inversely associated with HOMA-IR indices (r = − 0.25, P = 0.025). In multivariable analysis for adjusting confounder factors, vitamin D non-deficiency was also negatively correlated with HOMA-IR compared to vitamin D deficiency (β = − 1.289, P = 0.026).ConclusionsTaken together, our findings suggest that serum 25(OH) D levels were inversely associated with HOMA-IR in AMA. Furthermore, pregnant women in AMA with vitamin D deficiency might have higher HOMA-IR levels than those with vitamin D non-deficiency.Trial registrationChinese Clinical Trial Registry (No. ChiCTR-RRC-16008714). retrospectively registered.

Effects of two-child policy on cesarean section rate in China: analysis under Robson Ten-Group Classification

Objective To investigate the changes in cesarean section rate(CSR) after the announcement of universal two-child policy using the Robson Ten-Group Classification. Methods A retrospective study was conducted to analyze 9 734 deliveries in the First Affiliated Hospital of Soochow University from January 2013 to August 2016. All deliveries were classified by the Robson Ten-Group Classification System and divided into three subgroups including phase 1(delivered between January 2013 and November 2013, the period before the selective two-child policy was implemented), phase 3( delivered between October 2015 and August 2016, the period after the universal two-child policy was implemented) and phase 2 (delivered between December 2013 and September 2015, the transition period from selective two-child policy to the universal two-child policy). Changes in CSR were analyzed by Chi-square test and Logistic regression. Results The cesarean section deliveries in Group 2b (singleton, cephalic presentation, primipara, ≥37 gestational weeks, cesarean section before labor) and group 5 (singleton, cephalic presentation, multipara with at least one cesarean section history, ≥37 gestational weeks) accounted for 52.78% (2 062/3 907) of the total cesarean section deliveries. The overall CSR decreased in phase 3 than in phase 1 [34.29% (654/1 907) vs 43.71% (1 112/2 544), χ2=40.376, P=0.000], and the most remarkable decline was found in group 2b [5.35% (102/1 907) vs 14.27% (363/2 544), χ2=92.700, P=0.000]. Compared with phase 1, in all deliveries, the constituent ratio of deliveries of groups 1 and 2 (singleton, cephalic presentation, primipara, ≥37 gestational weeks) was decreased in phase 3 [50.24% (958/1 907) vs 60.34% (1 535/2 544), χ2=45.145, P=0.000], while that in groups 3 and 4 (singleton, cephalic presentation, multipara, ≥37 gestational weeks, no cesarean section history) [21.66% (413/1 907) vs 16.71% (425/2 544), χ2=17.483, P=0.000] as well as in group 5 [14.47% (276/1 907) vs 9.28% (236/2 544), χ2=28.910, P=0.000] were increased. In group 5, the rate of vaginal birth after cesarean in phase 3 was higher than that in phase 1 [17.39% (48/276) vs 2.54% (6/236), χ2=29.732, P=0.000]. Conclusions The proportion of multiparae significantly increases, while the overall CSR significantly decreases after the implementation of universal two-child policy in China. Gravidas in groups 2b (singleton, cephalic presentation, primipara, ≥37 gestational weeks, cesarean section before labor) and 5 (singelon, cephalic presentation, multipara with at least one cesarean section history, ≥37 gestational weeks) are the most important target population in attempting to reduce CSR in China. Key words: Cesarean section; Logistic models; Population surveillance

Nutritional status and interventional strategies during pregnancy in China

Pregnancy is where a life begins, and the nutritional status of a pregnant woman has profound impact on the short- and long-term health for both her child and herself. With the improvement of living standards, pregnant women in China are in better nutritional condition, but still face the double challenges of excessive calories intake and insufficient intake of some micronutrients. Inadequate weight gain during pregnancy is common, especially excessive weight gain. We are now facing a more serious challenge in nutrition management during pregnancy due to the persistent high prevalence of some complications, including iron deficiency anemia, gestational diabetes mellitus and macrosomia,etc, and the increasing proportion of high-risk gravidas after the implementation of universal two-child policy . Therefore, to have a better understanding of the current nutritional status of pregnant women and develop practical measures, such as strengthening nutrition education and management during pregnancy, are of great significance in improving perinatal outcomes and preventing chronic diseases in adulthood in offspring. Key words: Pregnant women; Nutritional status; Pregnancy outcome; Preventive health services