Two-child Policy In China Research Articles

Burden of multiple high-risk factors in pregnancy before and after the universal two-child policy in Chinese women: An observational study.

The prevalence of high-risk pregnancy increased after the implementation of two-child policy in China, but the impact of this policy change on the burden and profile of multiple high-risk factors in pregnancy (MHFP) has been insufficiently explored. We hypothesised that the profile of MHFP might have changed after the two-child policy was implemented and aimed to estimate the prevalence, intercorrelation, and outcomes of MHFP before and after its introduction. We obtained data on the population of pregnant women before (2015) and after (2020/2021) the implementation of universal two-child policy in Huai'an. We then included 33 risk factors in our analysis based on the Five-Colour Management framework and defined MHFP as an individual having two or more of these factors. We also estimated the changes of the prevalence of each single factor and their coexistence. Lastly, we performed a network analysis to assess the intercorrelations across these factors and used logistic regression models to evaluate MHFP-related pregnancy outcomes. We observed an increase in the prevalence of MHFP after the implementation of the universal two-child policy (25.8% in 2015 vs 38.4% in 2020/2021, P < 0.01). Chronic conditions (e.g. gestational diabetes mellitus, abnormal body mass index) had the largest increase among the included factors, while cardiovascular disease and hypertensive disorders were central factors of the network structures. The correlations of advanced maternal age with abnormal pregnancy histories and scarred uteri increased significantly from 2015 to 2020/2021. MHFP was associated with multiple pregnancy outcomes, including preterm birth (adjusted odds ratio (aOR) = 2.57; 95% confidence interval (CI) = 2.39-2.75), low birthweight (aOR = 2.77; 95% CI = 2.54-3.02), low Apgar score (aOR = 1.41; 95% CI = 1.19-1.67), perinatal death (aOR = 1.75; 95% CI = 1.44-2.12), and neonatal death (aOR = 1.76; 95% CI = 1.42-2.18). Moreover, an increasing number and certain combinations of MHFP were associated with higher odds of pregnancy outcomes. For example, the aOR of preterm birth increased from 1.67 (95% CI = 1.52-1.87) for one risk factor to 8.03 (95% CI = 6.99-9.22) for ≥4 risk factors. Chinese women experienced a higher burden of multiple high-risk factors after the introduction of the two-child policy, particularly those with advanced maternal age, obesity, and chronic conditions. Strategies targeting chronic conditions for women with MHFP should be prioritised and a shift to a multiple-factor-oriented framework is needed in the expanding Chinese maternal health care system.

Vitrification preservation of good-quality blastocysts for more than 5years reduces implantation and live birth rates.

Does vitrification cryopreservation of embryos for more than 5 years affect the pregnancy outcomes after frozen embryo transfer (FET)? Vitrification cryopreservation of good-quality blastocysts for more than 5 years is associated with a decrease in the implantation rate (IR) and live birth rate (LBR). Previous studies have predominantly focused on embryos cryopreserved for relatively short durations (less than 5 years), yet the impact of extended cryopreservation duration on pregnancy outcomes remains a controversial issue. There is a relative scarcity of data regarding the efficacy and safety of storing embryos for 5 years or longer. This retrospective study involved 36665 eligible vitrified-thawed embryo transfer cycles from 1 January 2016 to 31 December 2022, at a single fertility center in China. Patients were divided into three groups according to embryo storage time: Group 1 consisted of 31565 cycles, with storage time of 0-2 years; Group 2 consisted of 4458 cycles, with a storage time of 2-5 years; and Group 3 included 642 cycles, with storage time exceeding 5 years. The main outcome measures were IR and LBR. Secondary outcome variables included rates of biochemical pregnancy, multiple pregnancy, ectopic pregnancy, and miscarriage, as well as neonatal outcomes. Reproductive outcomes were analyzed as binary variables. Multivariate logistic regression analysis was used to explore the effect of preservation time on pregnancy outcomes after correcting for confounding factors. In addition, we also assessed neonatal outcomes, such as large for gestational age (LGA) and small for gestational age (SGA). IRs in the three groups (0-2, 2-5, and >5 years) were 37.37%, 39.03%, and 35.78%, respectively (P = 0.017), and LBRs in the three groups were 37.29%, 39.09%, and 34.91%, respectively (P = 0.028). After adjustment for potential confounding factors, compared with the 0-2 years storage group, prolonged embryo vitrification preservation time (2-5 years or >5 years) did not affect secondary outcomes such as rates of biochemical pregnancy, multiple pregnancy, ectopic pregnancy, and miscarriage (P > 0.05). But cryopreservation of embryos for more than 5 years reduced the IR (adjusted odds ratio (aOR) 0.82, 95% CI 0.69-0.97, P = 0.020) and LBR (aOR 0.76, 95% CI 0.64-0.91, P = 0.002). Multivariate stratified analysis also showed that prolonging the cryopreservation time of blastocysts (>5 years) reduced the IR (aOR 0.78, 95% CI 0.62-0.98, P = 0.033) and LBR (aOR 0.68, 95% CI 0.53-0.87, P = 0.002). However, no effect on cleavage embryos was observed (P > 0.05). We further conducted stratified analyses based on the number and quality of frozen blastocysts transferred, and the results showed that the FET results after transfers of good-quality blastocysts in the >5 years storage group were negatively affected. However, the storage time of non-good-quality blastocysts was not significantly associated with pregnancy outcomes. Regarding the neonatal outcomes (of singletons), embryo vitrification preservation time had no effect on preterm birth rates, fetal birth weight, or neonatal sex ratios. However, as the storage time increased, rates of SGA (5.60%, 4.10%, and 1.18%) decreased, while rates of LGA (5.22%, 6.75%, and 9.47%) increased (P < 0.05). After adjusting for confounding factors, the increase in LGA and the decrease in SGA were significantly correlated with the duration of storage time. This was a retrospective study using data from a single fertility center, even though the data had been adjusted, our findings still need to be validated in further studies. With the full implementation of the two-child policy in China, there may be more patients whose embryos have been frozen for a longer time in the future. Patients should be aware that the IR and LBR of blastocysts are negatively affected when the cryopreservation time is longer than 5 years. Couples may therefore consider shortening the time until FET treatment. This study was supported by the National Nature Science Foundation of China (No. 82101672), Science and Technology Projects in Guangzhou (No. 2024A03J0180), General Guidance Program for Western Medicine of Guangzhou Municipal Health Commission (No. 20231A011096), and the Medical Key Discipline of Guangzhou (2021-2023). None of the authors have any conflicts of interest to declare. N/A.

Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China’s universal two-child policy: a real-world retrospective study, 2010–2021

BackgroundIn 2016, the “universal two-child” policy, allowing each couple to have two children, was introduced in China. The characteristic change of the long-term period after the implementation of the universal two-child policy was unclear. We studied trends in the obstetric characteristics and their potential impact on the rates of cesarean section and preterm birth in the era of China’s universal two-child policy.MethodsA tertiary center-based study (2010–2021) retrospectively focused single high-risk pregnancies who delivered from the one-child policy period (OCP, 2010–2015) to the universal two-child policy period (TCP, 2016–2021). A total of 39, 016 pregnancies were enrolled. Maternal demographics, complications, delivery mode and obstetric outcomes were analyzed. Furthermore, logistic regression analysis was used to explore the association between the cesarean section rate, preterm birth and implementation of the universal two-child policy, adjusting maternal age, parity, and fetal distress.ResultsUltimately a total of 39,016 pregnant women met the criteria and were included in this analysis. The proportion of women with advanced maternal age (AMA) increased from 14.6% in the OCP to 31.6% in the TCP. The number of multiparous women increased 2-fold in the TCP. In addition, the overall rate of cesarean section significantly decreased over the policy change, regardless of maternal age, whereas the risk of preterm birth significantly increased in the TCP. Adjusting for maternal age, parity and fetal distress, the universal two-child policy showed a significantly favorable impact on the cesarean section rate (RR 0.745, 95%CI (0.714–0.777), P < 0.001). Compared to the OCP group, a higher increase in fetal distress and premature rupture of membranes (PROM) were observed in the TCP group. In pregnancies with AMA, there was no increase in the risk of postpartum hemorrhage, whereas more women who younger than 35 years old suffered from postpartum hemorrhage in TCP. The logistic regression model showed that the universal two-child policy was positively associated with the risk of postpartum hemorrhage (RR: 1.135, 95%CI: 1.025–1.257, P = 0.015).ConclusionsAfter the implementation of the universal two-child policy in China, the rate of the cesarean section significantly decreased, especially for women under 35 years old. However, the overall risk of postpartum hemorrhage increased in women under 35 years old, while there was no change in women with AMA. Under the new population policy, the prevention of postpartum hemorrhage in the young women should not be neglected.

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.

An Analysis of the Policy Change from One-Child to the Universal Two-Child in China -- Based on the Theories of the Advocacy Coalition Framework

In the early 20th century, China gradually adjusted its family planning policy due to the unbalanced population structure. From the selective two-child policy in 2013 to the universal two-child policy in 2016, China ended the one-child policy that had lasted for decades. In fact, after the implementation of the selective two-child policy, it has always been a hot topic of public debate. However, the government has been cautious about this issue and has yet to make a clear statement. After much debate, the universal two-child policy was introduced. The existing literature mainly analyzes the reason and purpose of introducing the two-child policy but rarely analyzes the policy agenda setting in the process of policy change. Therefore, this paper will analyze Chinas fertility system based on the agenda-setting processs internal mechanism. As the leading theory of agenda setting, the Advocacy Coalition Framework (ACF) helps explain the causal relationship between the policy of one child and the policy of universal two-child policy in China; this provides a new perspective for understanding Chinas general and significant policy changes. Therefore, this paper will analyze the internal logic and the dynamic mechanism of the process of two-child policy change and assess the interpretation limits of the Advocacy Coalition Framework in the policy process in China.

Do housing booms reduce fertility intentions? Evidence from the new two-child policy in China

To ease pressure from the aging population, the Chinese government implemented a two-child policy for couples where either the husband or the wife is from a single-child family in 2014. Using this policy as a quasi-natural experiment, we find that housing booms inhibit the potential desire for more children. A one-standard-deviation increase in the housing price-income ratio decreases the probability of migrant couples’ intention to have a second child by 7.69%, with the effect being concentrated on renters. Housing booms affect couples’ desired fertility through negative income and high opportunity cost channels. (JEL code: R31, J13, J38).

Interactions between long interpregnancy interval and advanced maternal age on neonatal outcomes.

After the implementation of the universal two-child policy in China, it was more frequent to have long interpregnancy intervals (IPIs) and advanced maternal age. However, the interactions between long IPIs and advanced maternal age onneonataloutcomes are unknown. The study subjects of this historical cohort study were multiparas with singleton live births between October 1st, 2015, and October 31st, 2020. IPI was defined as the interval between delivery and conception of the subsequent pregnancy. Logistic regression models were used to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of the risks of preterm birth (PTB), low birth weight (LBW), small for gestation age, and 1-min Apgar score ≤ 7 in different IPI groups. Relative excess risk due to interaction (RERI) was used to evaluate the additive interaction between long IPIs and advanced maternal age. Compared with the 24 ≤ IPI ≤ 59months group, the long IPI group (IPI ≥ 60months) was associated with a higher risk of PTB (aOR, 1.27; 95% CI: 1.07-1.50), LBW (aOR, 1.32; 95% CI 1.08-1.61), and one-minute Apgar score ≤ 7 (aOR, 1.46; 95% CI 1.07-1.98). Negative additive interactions (all RERIs < 0) existed between long IPIs and advanced maternal age for these neonatal outcomes. Meanwhile, IPI < 12months was also associated with PTB (aOR, 1.51; 95% CI 1.13-2.01), LBW (aOR, 1.50; 95% CI 1.09-2.07), and 1-min Apgar score ≤ 7 (aOR, 1.93; 95% CI 1.23-3.04). Both short and long IPIs are associated with an increased risk of adverse neonatal outcomes. Appropriate IPI should be recommended to women planning to become pregnant again. In addition, better antenatal care might be taken to balance the inferiority of advanced maternal age and to improve neonatal outcomes.

Whose Preference Matters More? Couple’s Fertility Preferences and Realization in the Context of China’s Two-Child Policy

The universal two-child policy in China did not lead to a significant increase in fertility, which results in many public debates. In this study, we examine to what extent a couple’s desires for more children are associated with their behavior for having a second child, and whether there is a gender power imbalance in the realization process. Using the China Family Panel Studies data in 2014 and 2018, the findings suggest that the overall rate of having a second child is low after the policy relaxation. Compared to wives, husbands have greater power in the second-child realization, and this phenomenon is only salient in rural areas. Education, as an indicator of resources and a tool of empowerment, played a limited role in reversing the husband’s dominance in fertility outcomes in rural areas. This study sheds light on domestic power relations and fertility realization in an era right after the policy relaxation in China and calls for policies to target the issues of how to raise fertility levels without sacrificing women’s interests.

Fertility policy and stock market participation: Evidence from the universal two-child policy in China

The Universal Two-Child Policy (UTCP) was implemented in 2016 to mitigate China's aging society. Based on the China Household Finance Survey in 2015 and 2017, this paper applies a difference-in-difference (DID) model to investigate the UTCP's impact on households' stock market participation behavior. The results show that the UTCP has a negative impact on stock market participation, which reduces households' stock market participation ratio as well as stock allocation in their financial portfolios. This decline is caused by the change in the risk preference of households. Furthermore, the impact of UTCP is more pronounced for households that are more risk averse, households that live in first- and second-tier cities, households that live in central and eastern China and households that have already had one child. Overall, this study provides new insights into the impact of China's UTCP on households' economic behavior and their decisions regarding financial market participation.

The economics of marriage: Evidence from China

Marriage market imbalances are common in modern society for social and economic reasons, including the increased cost of marriage caused by high housing prices and an imbalance in the number of men and women. We draw on the family economic theory of Gary Becker to study the general equilibrium of the marriage market in China. On the one hand, we find that the increasing price of houses, an important measure of marriage cost, has significantly reduced the marriage rate in China. Another determining factor that has reduced the marriage rate is an imbalance in the sex ratio, with more men than women, as a result of China’s one-child policy. On the other hand, higher GDP and educational levels have positive effects on the marriage rate. Interestingly, the rise in housing prices after the implementation of the two-child policy in China has had a more negative impact on the marriage rate. Overall, our findings have important policy implications for government.

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.

The prevalence of gestational diabetes mellitus before and after the implementation of the universal two-child policy in China.

BackgroundAfter the universal two-child policy has been fully implemented, challenges regarding pregnancy complications seemed to be more severe in China. This study aimed to evaluate the prevalence of gestational diabetes mellitus (GDM) and the main risk factors for GDM before and after the implementation of the universal two-child policy in China.MethodsA retrospective study was performed with 128,270 pregnant women who delivered at Ningbo Women & Children’s Hospital from January 2010 to December 2020. Univariate and multivariate logistic regression analysis was applied to estimate the risk factors associated with GDM prevalence. Segmented regression analyses of interrupted time series (ITS) were conducted to assess the effect of the universal two-child policy on the trends of GDM.ResultsThe prevalence of GDM increased remarkably from 4% in 2010 to 21% in 2020. ITS analysis presented that the prevalence of GDM increased by 0.190% (β1) per month from 2010 to 2016 (P<0.05), and by 0.044% (β1+β3) per month after the implementation of the universal two-child policy; the rate of elevation of GDM slowed down significantly (β3=-0.146, P=0.004). Advanced maternal age (>30 years), multigravidity, multiparity, multiple gestation and gestational hypertension were significantly associated with GDM. Advanced age remained an independent risk factor for GDM even after cross stratification with gravidity and parity. The proportion of women with advanced maternal age (>30 years) increased by 0.161% per month before the implementation of the universal two-child policy and increased by 5.25% during the policy took effect month, and gradually increased by 0.124% (β1+β3) per month after then.ConclusionsThe prevalence of GDM has sharply increased in the past decade. The growth rate of GDM slowed down after the implementation of the universal two-child policy in China, but the rate would maintain at a high plateau. The rise in the proportion of older pregnant women could increase the GDM rate. We recommend having children at a relatively optimal reproductive age when encouraging childbearing.

Incidence and risk factors of infertility among couples who desire a first and second child in Shanghai, China: a facility-based prospective cohort study

BackgroundWith the implementation of the two-child policy in China, more couples have expressed the desire to have another child. We conducted this study to evaluate the incidence of infertility and risk factors in couples intending to have a first and second child.MethodsFrom 2013 to 2017, a prospective cohort study was conducted at the pre-pregnancy center of the International Peace Maternal and Child Health Hospital. The participants were selected by screening and random sampling couples who came to the pre-pregnancy center. Data regarding patient sociodemographic characteristics, reproductive and gynecological history, male disease history, and laboratory and imaging examination results were collected. Couples were followed up every 3 months until pregnancy or for 12 months, whichever came first. Multi-factor logistic regression was used to analyze risk factors for infertility. Adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors.ResultsThe overall infertility incidence was 16.95% (369/2177). The infertility incidence of “first child intention” and “second child intention” was 19.30% (355/1839) and 4.14% (14/338), respectively. This study found great differences in both infertility rate (P < 0.001) and risk factors between the two groups. Risk factors for “first child intention” infertility included advanced age (> 35 years) (aOR = 1.70, 95% CI 1.27–2.28), abnormal body mass index (BMI) (aOR = 1.58, 95% CI 1.31–6.26), longer menstrual periods (aOR = 4.47, 95% CI 2.25–8.88), endometrial polyps (aOR = 2.52, 95% CI 1.28–4.97), polycystic ovarian syndrome (PCOS) (aOR = 6.72, 95% CI 1.79–7.39), salpingostomy (aOR = 3.44, 95% CI 1.68–7.07), and history of mycoplasma (aOR = 1.54, 95% CI 1.09–2.40). However, in the “second child intention” group, clinical risk factors slightly differed and included leiomyoma (aOR = 5.60, 95% CI 1.06–29.76), and higher age (> 40 years) (aOR = 7.36, 95% CI 1.01–53.84).ConclusionThe overall infertility rate in Shanghai is similar to that of other large cities in China. Marriage at advanced ages has become increasingly common. As such, the government must consider subsidies to encourage childbirth at childbearing ages, which can improve fertility levels.

Global gridded GDP data set consistent with the shared socioeconomic pathways

The vulnerability, exposure and resilience of socioeconomic activities to future climate extremes call for high-resolution gridded GDP in climate change adaptation and mitigation research. While global socioeconomic projections are provided mainly at the national level, and downscaling approaches using nighttime light (NTL) images or gridded population data can increase the uncertainty due to limitations. Therefore, we adopt an NTL-population-based approach, which exhibits higher accuracy in socioeconomic disaggregation. Gross regional product of over 800 provinces, which covering over 60% of the global land surface and accounted for more than 80% of GDP in 2005, were used as input. We present a first set of comparable spatially explicit global gridded GDP projections with fine spatial resolutions of 30 arc-seconds and 0.25 arc-degrees for the historical period of 2005 and for 2030–2100 at 10-year intervals under the five SSPs, accounting for the two-child policy in China. This gridded GDP projection dataset can broaden the applicability of GDP data, the availability of which is necessary for socioeconomic and climate change research.

Changes in sexual frequency among 51 150 infertile Chinese couples over the past 10 years.

How did the sexual frequency change and what are the related influencing factors among infertile Chinese couples over the past 10 years? Sexual frequency has declined among infertile Chinese couples over the past decade, with such declines being most pronounced for women between the ages of 18 and 39. Many researchers have explored trends in coital frequency and variables associated among healthy individuals in other nations. There have been major changes in all aspects of Chinese life and society over the past decade, including two major fertility policy adjustments. The sexual habits of infertile couples in China remain poorly understood and warrant further investigation. A retrospective cohort study of 51 150 infertile couples that visited our facility between January 2011 and December 2020 at a tertiary care academic medical centre. The primary outcome for this study was whether couples had engaged in sexual intercourse ≤4 times/month or >4 times/month. Multivariable logistic regression analyses were performed to detect the association between the variables and sexual frequency. Analyses were further performed to determine whether observed trends remained evident in women from different age subgroups. To assess whether these trends differed before and after the introduction of the universal two-child policy in China (January 2016), we additionally assessed trends in these age subgroups of women relative to the time at which this policy was introduced. The proportion of couples reporting having engaged in sexual intercourse >4 times/month fell over the past decade from 62.7% (2011-2013) to 55.9% (2014-2015) to 52.7% (2016-2020). Declines in sexual frequency were evident for women between the ages of 18 and 39 (P < 0.05), whereas no such changes were evident for women between the ages of 40 and 50. Younger men and women, as well as individuals with a less than junior college education level, reported higher frequencies of sexual intercourse. For women, being remarried and having a more recent diagnosis of infertility were associated with increased coital frequency. This frequency decreased progressively for women as BMI values increased. There was no detected relationship between coital frequency and nationality or history of prior births. These analyses were dependent on self-reported data, and may thus have been impacted by the over- or under-reporting of sexual frequency as a consequence of social desirability bias. In addition, not all potentially relevant variables were assessed in all analyses, and certain potentially relevant variables such as family income or pornography use were not measured in any analyses. Sexual frequency is closely related to infertility risks. This general downward trend in sexual frequency may warrant concern. At present, these reductions remain an interesting yet unexplained topic worthy of further study. This study was funded by the National Key Research and Development Program of China (Grant no. 2018YFC1003000) and the National Natural Science Foundation of China (Grant no. 81771533). The authors declare no conflict of interest. N/A.

Medical expenditure of women during pregnancy, childbirth and puerperium at the beginning of China’s universal two-child policy enactment: a population-based retrospective study

ObjectivesTo describe and explore women’s medical expenditures during pregnancy, childbirth and puerperium at the beginning of the universal two-child policy enactment in China.DesignPopulation-based retrospective study.SettingDalian, China.ParticipantsUnder the System of Health...

Estimates of inpatient admission rates and associated costs for infants before and after China\u2019s universal two-child policy

BackgroundChina implemented a universal two-child policy in 2015. It is important to understand infants’ medical utilization in the context of this policy to inform health policies and resource allocation.MethodsThis study utilized a 20% random sample of administrative data from China’s Urban and Rural Basic Medical Insurance (URBMI) in one of the largest southern Chinese cities from January 2015 to June 2018. Ordinary least squares models were used to estimate changes in inpatient admission rates and costs for infants between 0 and 6 months old after the implementation of China’s universal two-child policy.ResultsThe overall inpatient admission rate was 27.2% in 2015 and 31.3% in 2017. Compared with 2015, there was an increase in inpatient admission rates for infants 1 month old or younger (coef = 0.038, 95% CI = 0.029 to 0.047, p < .001) and infants 6 months old or younger (coef = 0.041, 95% CI = 0.030 to 0.052, p < .001) in 2017. The increase was larger for male infants than for female ones. The average inpatient admission cost was 8412.3 RMB ($1320.61) (SD = 15,088.2). There was no increase in inpatient admission costs overall. The average length of hospital stay was 7.3 days, the probability of going to a tertiary hospital was 76.2%, and the share of out-of-pocket costs was 53.0% for all diseases.ConclusionAfter the implementation of the universal two-child policy in China, there was a significant increase in inpatient admission rates, especially for male infants. The overall associated costs did not change, but the increase in admission rates caused additional economic burdens for families and for social health insurance. Understanding the healthcare utilization of infants in the universal two-child period can provide insight for healthcare resource allocation in a time of dramatic changes in population policy.

Widowhood and Life Satisfaction Among Chinese Elderly Adults: The Influences of Lifestyles and Number of Children.

Our study examined how lifestyle and number of children influence the relationship between widowhood and life satisfaction based on self-regulation theory. A sample of 2,968 elderly respondents (male = 1,515, female = 1,453, mean age = 69.12 years, SD = 7.24) participated in Chinese General Social Survey. Our findings suggest that lifestyle is positively related to life satisfaction, and number of children is positively associated with life satisfaction but negatively related to lifestyle. The moderated mediation model demonstrated that lifestyle partly mediated the relationship between widowhood and life satisfaction. Moreover, number of children moderated the relationship between widowhood and lifestyle and between lifestyle and satisfaction with life. Widowed elderly individuals who have more children are likely to show a higher level of satisfaction with life. The present study has significance in practice because it provides empirical implications obtained from a national survey on the universal two-child policy in China as two children might decrease the negative impacts of widowhood on life satisfaction.

The Effect of China's Two-Child Policy on the Child Sex Ratio: Evidence From Shanghai, China.

Objective: The bias towards males at birth has resulted in a major imbalance in the Chinese sex ratio that is often attributed to China’s one-child policy. Relaxation of the one-child policy has the potential to reduce the imbalance in the sex ratio away from males. In this study, we assessed whether the bias towards males in the child sex ratio was reduced as a result of the two-child policy in China. Medical records data from one large municipal-level obstetrics hospital in Shanghai, East China. Design: Matching and difference-in-differences (MDID) techniques were used to investigate the effect of the two-child policy on the imbalance in the sex ratio at birth after matching for pregnancy status and socioeconomic factors. Results: Analyzing 133,358 live births suggest that the relaxation of the one-child policy had a small, but statistically significant effect in reducing the imbalance in the male to female sex ratio at birth. Conclusion: The results demonstrate that relaxation of the one-child policy reduced the imbalance in the male to female sex ratio at birth from 1.10 to 1.05 over the study period at one of the major obstetrics and gynecology hospitals in China.

Research on Teaching Reform of Kindergarten Language Education Activities

With the implementation of the two-child policy in China, early childhood education has attracted great attention from the society and families. However, the current preschool language education can no longer meet the needs of development, and it is necessary to reform the preschool language education and training mode. It is particularly important to strengthen the combination of work and study through curriculum reform and find a path suitable for kindergarten language education.