Under China's one-child policy, the new generation of nursing students has gradually entered the workforce. Their career commitment, career self-efficacy, and sense of calling have undergone changes. It is necessary to assess the relationships and underlying mechanisms among these factors in order to stabilize the nursing workforce and cultivate high-quality clinical nursing professionals. A cross-lagged design was used, with a total of 693 nursing students participating in September and December 2022. The 27-item undergraduate career commitment scale, the Chinese version of career self-efficacy scale, and the brief calling scale were measured over time. The relationships between career commitment, career self-efficacy, and sense of calling differed by only child and non-only child nursing undergraduates. It is important to introduce specific measures aimed at enhancing the quality of nursing education and implementing effective nursing management methods to ensure the stability of the nursing workforce.

Abstract In China, child trafficking remains a critical public safety issue that undermines family harmony and social stability. However, the various factors contributing to child trafficking at the origin have not been thoroughly investigated due to data scarcity. To address this gap, this study utilized a database from a public welfare website dedicated to missing persons to collect 9016 child trafficking cases recorded between 1949 and 2022 in Southwest China. We then employed the Local Moran’s I spatial statistic to identify spatial clusters of child trafficking. The stepwise regression model was employed to examine the association between socioeconomic, demographic, and policy factors and child trafficking in the origin areas. The results indicated that prior to 1985, child trafficking exhibited spatial clustering in the adjacent regions of Sichuan and Chongqing. Subsequently, an intense spatial clustering emerged in the adjacent regions of Yunnan, Guizhou, Sichuan, and Chongqing. Large income disparities and high unemployment rates were the direct factors contributing to child trafficking. This issue was exacerbated by low education levels. Families with more children faced a higher risk of child trafficking due to lower levels of guardianship. Diverse festivals created more opportunities for child trafficking to take place. Additionally, the impact of the one-child policy on child trafficking was prominent during a specific period. Therefore, authorities should comprehensively consider these factors to formulate strategies and reduce child trafficking.

ABSTRACT This paper investigates the causal effects of China’s One-Child Policy on marriage market outcomes using nationally representative data. We employ a regression discontinuity – difference-in-differences approach that exploits birth-month discontinuities around policy implementation. Results show the policy generated a significant ‘marriage premium’ for women, who married more established partners with urban residency and higher occupational prestige. Men experienced no comparable advantages, revealing pronounced gender asymmetry. This reflects how the policy eliminated traditional son-preference in family investment, enabling daughters to receive concentrated resources that enhanced their marital prospects. Our findings demonstrate how demographic policies can reshape socioeconomic mobility through marriage markets.

China has experienced a population decline since 2022, and its total fertility rate has dropped to about 1.0 in 2025. This is despite the lifting of the one-child policy in 2015 and the pivot to the two-child policy and three-child policy in, respectively, 2016 and 2021. Based on a review of recent research, this paper provides an interpretation that the continued fertility decline reflects a perfect storm of socioeconomic and demographic processes, long-term effects of the one-child policy, and unprecedented social changes in Chinese society. Socioeconomic and demographic changes since the 1950s prepared the ground for the “late, sparse, few” policy, resulting in a sharp fertility decline in the 1970s. While the one-child policy that followed did not result in a fertility decline in the 1980s, its effects appear to be long-lasting, including concentrated investment by the “inverted family” in the only child that drives up society-wide childrearing costs. Significant improvement in women’s educational attainment, individualistic orientation that prioritizes personal goals, increased diversity in family structure, such as one-person households, and changing views about getting married and having children have all contributed to continued downward pressure on fertility. These findings hint at the relevance of the concept of the second demographic transition for China and suggest that policy is only effective if it is aligned with what people want.

After over three decades of the one-child policy (OCP), China introduced the partial two-child policy (PTCP) in 2013 and the universal two-child policy (UTCP) in 2015. However, their potential impacts on maternal and neonatal health remain unclear. This study aimed to examine temporal changes in maternal characteristics and neonatal outcomes across different policy periods. We used data from a population-based pregnancy registry in Ximen, China. Maternal characteristics and neonatal outcomes were compared across the three periods: OCP (2012-2014), PTCP (2014-2016), and UTCP (2016-2021). Joinpoint regression and interrupted time series (ITS) model were applied to evaluate temporal trends and quantify the effect of policy implementation on trends over time. Among 491895 pregnancies, the proportion of advanced maternal age and multiparity rose significantly after policy shifts. Maternal obesity, hypertensive disorders of pregnancy, and gestational diabetes showed steady increases. Monthly births peaked in 2016, then declined below the pre-PTCP baseline level by 2020. Compared to OCP, the prevalence of birth defects (BDs) increased by 62% during PTCP and 204% during UTCP. Preterm birth and low Apgar scores also rose. ITS indicated a significant post-UTCP acceleration in BDs (β3 = 2.57), largely driven by circulatory system BDs, with maternal age acting as a partial mediator. China's TCP implementation was associated with notable shifts in maternal risk profiles and increased adverse neonatal outcomes, underscoring the need for continuous maternal-child health monitoring during fertility policy transitions.

This paper examines Chinese women’s fertility intentions and attitudes toward motherhood following the implementation of the three-child policy announced in May 2021. Drawing on Minello’s theoretical framework for analyzing declining fertility, I argue that the reproductive choices of Chinese women are not influenced by the possibility of having additional children, but rather by the disjuncture between the structural and cultural dimensions of contemporary Chinese society. Market liberalization and the privatization of welfare services following the economic reforms of the 1980s created a disjuncture between the material needs of Chinese families and the traditional cultural assumptions regarding family and maternity, which was exacerbated by the introduction of the one-child policy and subsequently of the two-child policy. Against this background, the implementation of the three-child policy continues to stimulate forms of awareness and reflection concerning women’s bodily autonomy, reproductive agency, and fertility intentions. Employing social media posts as case studies, this paper aims not only to underscore how birth rates are increasingly affected by economic and political structures, but also to stimulate reflection on material concerns and forms of dissent that, despite their cultural specificity, can serve as a bridge toward broader, non-Eurocentric feminist analyses of motherhood.

China's one-child policy was implemented in 1980 primarily through mandatory intrauterine devices, tubal surgery, or abortion for "unauthorized pregnancies." While it was replaced in 2015, it affected millions of persons and its effects on reproductive decision making are not well known. We designed, validated, and performed a cross-sectional survey of reproductive age Chinese-born or first-generation women of Chinese descent to describe the policy's impact on reproductive decision-making. Descriptive statistics and multivariate logistic regression were used to identify self-reported policy impact on contraceptive utilization and childbearing choices, and demographic associations. Between June 1 and October 31, 2021, 1098 people accessed the survey, and 838 were eligible. A total of 588 responded to questions pertaining to the primary outcome, yielding a response rate of 70.2%. Approximately 42% of participants lived under the policy and were affected by it in some way. 17.3% of participants stated their contraceptive utilization was affected and 23.3% stated their childbearing choices were affected. Those with low acculturation scores (OR = 2.27, 95% CI 1.35-3.85, p = 0.002) and those living in the United States for < 21 years (OR = 2.25, 95% CI 1.09-4.67, p < 0.01) were more likely to report their contraceptive plans were affected. 72.8% of participants self-reported high reproductive autonomy, whereas acculturation was mixed. Although the one-child policy has had a large effect on people of the Chinese diaspora, its impact on reproductive decision-making may decrease with the duration of time in the United States and increasing acculturation.

Fertility restriction, human capital investment and gender equality: Evidence from the one-child policy in China

Women's empowerment and participation in innovation: Evidence from the one-child policy in China

Abstract This study employs a multilevel institutional analysis to investigate the structural disintegration of intergenerational support systems and the rising prevalence of elderly empty-nesting in China’s Rust Belt (Northeast provinces), utilizing longitudinal population census data (2000–2020) and municipal socioeconomic records. Three critical findings emerge: (1) Accelerated Family Fractures: The Rust Belt exhibits a uniquely severe trajectory of aging and empty-nesting compared to national averages. While couple-only households dominate elderly empty-nesting (reflecting weakened intergenerational cohabitation norms), the surge in solitary living arrangements—a 23% faster growth rate than couple-only cases—signals deepening familial fragmentation. (2) Spatial Inequality as Institutional Legacy: Urban empty-nesting rates persistently surpass rural levels, yet resource-depleted cities face disproportionately high rates of solitary elderly households. Geospatial clustering reveals a “peripheralization” pattern: border zones of Heilongjiang-Jilin and industrial hubs in Liaoning exhibit peak empty-nesting, mirroring the region’s post-industrial decline and youth exodus. (3) Hierarchical Drivers of Institutional Failure: Mass outmigration (demographic driver) and state-led urbanization policies (economic driver) structurally erode family support capacities. The collapse of multigenerational cohabitation norms, amplified by decades of one-child policy legacies, accelerates household atomization. Solitary living correlates strongly with localized industrial collapse (e.g., mining towns), whereas couple-only households are primarily shaped by cultural inertia and demographic constraints. These findings challenge conventional narratives of filial piety decline, instead framing empty-nesting as a systemic outcome of China’s Rust Belt’s institutional trilemma: depopulation pressures, fragmented welfare systems, and unaddressed cultural-institutional voids.

Abstract Siblings are lifelong companions, providing both support and rivalry, yet their influence in later life remains underexplored in family research. This study examines how sibling number and gender shape the wealth and health trajectories of older adults in China, with a focus on gender differences in these relationships. Using four waves of China Health and Retirement Longitudinal Study (CHARLS) data and employing growth curve modeling, we find that having more siblings is generally associated with greater wealth and better physical and cognitive well-being in later life. While wealth and health decline with age, having siblings slows the trajectory of physical health decline but accelerates wealth reduction over time. Gender-specific analyses reveal that having sisters slows physical health decline, with stronger benefits for men than women. While males show greater resilience to age-related memory decline, having sisters weakens this advantage, whereas having brothers enhances it. These findings highlight the protective effects of sibling relationships on the physical and cognitive health of Chinese older adults. However, greater wealth decline among those with more siblings may stem from financial transfers for aging-related healthcare needs or diluted inheritance. Men also particularly benefit from sisters’ instrumental and emotional support, aligning with traditional caregiving expectations for women. As the one-child policy parent-generation enters later life in the coming decades, these findings suggest potential vulnerabilities in physical health trajectories and early-life wealth accumulation for their children, emphasizing the need for policy adaptations to support aging families.

Background and Aim: China's demographic transition from a "demographic dividend" phase, characterized by a youthful population and rapid economic growth, to an aging society presents multifaceted socioeconomic challenges. This shift has been accelerated by the legacy of the one-child policy, rising life expectancy, and pronounced regional disparities. Provincial variations in aging trajectories are critical. Heilongjiang faces severe aging due to outmigration and shrinking labor pools, Hebei exhibits deep urban-rural divides in aging impacts, and Hunan demonstrates moderate aging mitigated by intergenerational family support systems. This study investigates the heterogeneous economic consequences of population aging across these provinces, with a focus on labor market dynamics, fiscal sustainability, and long-term growth trajectories. By contextualizing aging within China's unique "getting old before getting rich" paradigm, we aim to inform region-specific policy responses. Materials and Methods: An augmented Solow growth model is employed to disentangle aging effects, incorporating province-level panel data (2004–2024) from China's National Bureau of Statistics and official provincial yearbooks. The model explicitly integrates aging-specific variables—including elderly dependency ratio, working-age population share, human capital stock, savings rate, and labor force participation rate—as both independent and interactive predictors. Econometric techniques include unit root testing for stationarity, cointegration analysis to validate long-term relationships, and fixed-effects regression to control for province-invariant characteristics. Model transparency is enhanced by specifying the functional form of aging variable incorporation and data standardization processes. Results: The elderly dependency ratio exhibits negligible direct effects on real per capita GDP. However, working-age population proportion (β=2.29, p&lt;0.1), human capital (β=5.08, p&lt;0.01), savings rate (β=3.86, p&lt;0.05), and labor participation (β=1.96, p&lt;0.01) significantly drive growth. Regional heterogeneity emerges. Heilongjiang’s labor shortages contrast with Hunan’s resilience from human capital investments, while Hebei’s urban-rural disparities underscore uneven aging impacts. Conclusion: Policy measures must prioritize region-specific strategies: enhancing vocational education in human-capital-deficient areas, incentivizing labor participation through flexible retirement, and expanding multi-pillar pension systems. Lessons from Japan’s automation adoption and Nordic flexible work models highlight feasible pathways. Aligning reforms with China’s “getting old before getting rich” context ensures sustainable adaptation to demographic shifts.

China has experienced changes in family planning policies and is currently undergoing a population decline. This study investigated not only whether the mothers of young children intend to have a second birth but also their perceptions and experiences related to this decision-making through 40 in-depth semi-structured interviews. At the time of the interviews, the sample mainly comprised parous women with one living biological child under six years old, along with women pregnant with their first child, in Guizhou and Shanghai, China. Study findings revealed that three decades of implementing the one-child policy have caused ideational changes in reproductive behaviours in Chinese mothers, many of whom prioritise self-achievement and self-realisation nowadays, while also adhering to traditional values such as gender-role divisions and son preference. The legacies of the one-child policy, along with the clash between new and traditional cultural values, influence mothers’ intentions to have a second child in China. Policymakers should consider the role of cultural and political factors in influencing second-child fertility intentions among women in China.

The factors that shape fertility preferences—and their transition to reality—have been widely discussed. However, very few empirical studies have estimated the causal effect of sibship size on fertility preferences. Using the case of urban China, this study examines if growing up as an only child can lead to lower fertility ideals. Exploiting the introduction of the one-child policy in 1980 and using a fuzzy regression discontinuity design, the study finds that, among individuals born right around 1980, the increased probability of being an only child significantly reduces the ideal number of children and the probability of desiring two or more children. The sibship size effect not only offers a plausible explanation for low fertility ideals in urban China but also attests to a key mechanism underlying the “Low-Fertility Trap” hypothesis.

China's single children policy, implemented from 1979 to 2015, lasted for 35 years, with the result that China is now the country with the highest number of children without siblings in the world. This policy profoundly reshaped China's family structure and parenting models, significantly impacting adolescents' physical health and Body Mass Index (BMI). This study analyzes data from the Chinese Adolescent Health Database, comprising 7,482 adolescents aged 12-18 years from 17 cities in Shandong Province collected between 2015 and 2020. The database includes indicators such as height, weight, 50-meter sprint, standing long jump, sit-and-reach, and vital capacity, which were assesses these indicators against the revised National Student Physical Health Standards of 2014 (CNSPHS). Using the Seemingly Unrelated Regression (SUR) model and Bayesian Model Averaging (BMA), the study examines the specific effects of being a single child on physical fitness test scores (PFTS) and BMI, and the nonlinear relationship linking the two. Among the participants, 28% (n = 2,089) were only children and 72% (n = 5,393) had siblings. The primary purpose of this study is to quantify the impact of China's one-child policy on adolescent physical health outcomes through rigorous statistical analysis, providing evidence-based insights for targeted interventions to improve health outcomes in this unique demographic group. The SUR regression indicated that the PFTS and BMI scores of single children were lower than those of multiple-child families' children by 1.412 and 1.213 points, respectively. Further analysis uncovered an inverted U-shaped relationship linking PFTS to BMI, indicating an optimal, moderate BMI range for physical health. These results highlight the importance of monitoring BMI in adolescent health management and underscore the necessity of targeted physical activities and nutritional guidance for single child. Being a single child has a significant negative impact on physical test scores and BMI, indicating potential vulnerabilities in their physical health. This discovery is crucial for policymakers and educators, prompting them to provide more opportunities for physical activity and to strengthen the cultivation of healthy eating habits among only children, thereby enhancing their physical health and overall well-being.

This study examined the influence of gender, income, cultural background, and relationship stage on dating payment attitudes through a questionnaire survey. The sample comprised 30 participants20 males and 10 femalesborn between 1989 and 2006, including both international and domestic (Chinese) students. The findings do not fully align with traditional assumptions about dating payment behaviors, as neither gender nor income significantly predicted payment preferences. Splitting the bill was most common during first dates, whereas in stable romantic relationships, the proportion of men covering the cost increased significantly. Chinese domestic students showed a stronger tendency to split the bill equally, which may stem from the effects of the one-child policy and compulsory education, potentially making young people more attuned to their own emotions while also seeking more equal relationships. In contrast, international students maintained traditional male payment patterns but expressed stronger negative attitudes toward women unwilling to pay, suggesting a cultural rebound effect.

This paper examines the impact of China’s evolving birth policies on maternal and neonatal health outcomes, particularly the shift from the one-child to the universal two-child policy. This narrative review synthesizes literature and national data on China’s birth policies and their impact on high-risk pregnancy, structuring the analysis around policy evolution, key health indicators, and healthcare system challenges. The policy changes have resulted in a rise in pregnancies among women of advanced maternal age (AMA), leading to increased risks during pregnancy, childbirth, and postpartum. The paper highlights the strain these shifts have placed on China’s healthcare system, especially concerning the allocation of maternal healthcare resources and the management of high-risk pregnancies. It also discusses the challenges posed by rising cesarean section rates, complications from previous pregnancies, and the need for improved prenatal care, emergency obstetric services, and postpartum support. The paper concludes with recommendations for enhancing healthcare delivery, such as integrating specialized care units, improving early risk detection, and expanding social support systems for working parents, to address the growing maternal and neonatal health challenges in China.

China is currently grappling with a critically low fertility rate and rapidly aging population, both of which pose significant threats to its long-term socioeconomic sustainability. Despite the relaxation of the one-child policy, the fertility outcomes remain far below replacement levels, indicating that policy alone is insufficient. This study shifts focus from fertility intentions to the realization of these intentions, examining the impact of regional income inequality on the fertility gapdefined as the difference between an individual's ideal and actual number of children. Using panel data from the China General Social Survey (CGSS) spanning 2013 to 2023, this research employs a two-way fixed effects model at the province and year levels. Results indicate that higher regional income inequality significantly widens the fertility gap, primarily through intensifying individuals' sense of relative deprivation and lowering their perceived socioeconomic status. Furthermore, the heterogeneity analysis indicates that this negative impact is more pronounced among urban residents, individuals aged 30-40, and those residing in the eastern regions of China. These findings underscore the need to address economic inequality and implement targeted policy interventions to foster a more fertility-supportive environment.

This study adopts a systems perspective to examine the persistent effects of China’s One-Child Policy (OCP) on the subjective well-being of older adults, emphasizing structural persistence, reinforcing feedback, and path-dependent lock-in in complex socio-technical systems. Using nationally representative data from the China Longitudinal Aging Social Survey (CLASS-2014), we exploit the OCP’s formal rollout at the end of 1979—operationalized with a 1980 cutoff—as a quasi-natural experiment. A Fuzzy Regression Discontinuity (FRD) design identifies the Local Average Treatment Effect of being an only-child parent on late-life well-being, mitigating endogeneity from selection and omitted variables. Theoretically, we integrate three lenses—policy durability and lock-in, intergenerational support, and life course dynamics—to construct a cross-level transmission framework: macro-institutional environments shape substitution capacity and constraint sets; meso-level family restructuring reconfigures support network topology and intergenerational resource flows; micro-level life-course processes accumulate policy-induced adaptations through education, savings, occupation, and residence choices, with effects materializing in old age. Empirically, we find that the OCP significantly reduces subjective well-being among the first generation of affected parents decades later (2SLS estimate ≈ −0.23 on a 1–5 scale). The effects are heterogeneous: rural residents experience large negative impacts, urban effects are muted; men are more adversely affected than women; and individuals without spouses exhibit greater declines than those with spouses. Design validity is supported by a discontinuous shift in fertility at the threshold, smooth density and covariate balance around the cutoff, bandwidth insensitivity, “donut” RD robustness, and a placebo test among ethnic minorities exempt from strict enforcement. These results demonstrate how demographic policies generate lasting impacts on elderly well-being through transforming intergenerational support systems. Policy implications include strengthening rural pension and healthcare systems, expanding community-based eldercare services for spouseless elderly, and developing complementary support programs.

BackgroundChina’s evolving fertility policies (one-child to three-child) have shaped maternal and neonatal outcomes, but specific gaps in stillbirth epidemiology during policy transitions.MethodsThis retrospective cohort study analyzed 721,860 singleton pregnancies in 2011–2023, from 18 maternal near-miss surveillance hospitals in Hunan. Stillbirth rates were assessed across four policy periods: one-child (2011–2013), partial two-child (2013–2015), universal two-child (2016–2020), and three-child (2021–2023). Multivariable logistic regression identified risk factors, adjusting for fertility policy period, maternal demographics and maternal comorbidities. Trends over time were analyzed using segmented regression models.ResultsThe overall stillbirth rate was 7.02‰ (95% confidence interval [CI]: 6.82–7.21), declining significantly from 9.62‰ during the one-child policy to 5.73‰ (95%CI: 5.25–6.23) under the three-child policy (t = −4.22, p < 0.01). Key risk factors included maternal age < 24 years (adjusted odds ratio [aOR] = 1.77, 95%CI:1.63–1.92), multiparity (aOR = 1.27–2.82. p < 0.01), non-rural hospital delivery (aOR = 4.00–11.13, p < 0.01), education ≤9 years (aOR = 1.51–2.20, p < 0.01), not being married (aOR = 2.92–5.60, p < 0.01), and comorbidities: severe preeclampsia (aOR = 3.80, 95%CI: 3.36–4.29), chronic hypertension (aOR = 2.67, 95%CI: 2.09–3.37), placental abruption (aOR = 5.06, 95%CI: 4.11–6.16), and placenta previa (aOR = 1.55, 95%CI: 1.29–1.84). Paradoxically, prenatal diabetes was associated with reduced stillbirth risk (aOR = 0.86, 95%CI: 0.77–0.95). Temporal shifts revealed elevated stillbirth rates among advanced-age mothers pre-2016 versus rising rates in women <24 years post-policy liberalization. Only the partial two-child policy period (aOR = 1.15, 95%CI: 1.05–1.25) was associated with the risk of stillbirth.ConclusionChina’s fertility policy transitions correlate with dynamic stillbirth epidemiology, emphasizing age- and parity-specific vulnerabilities. Targeted interventions for high-risk subgroups, especially younger, less well-educated, multiparous women, and those with hypertensive or placental disorders, are critical amid ongoing implementation of the three-child policy.