Universal Two-child Policy Research Articles

Reproductive health status and related knowledge among women aged 20\u201339 years in rural China: a cross-sectional study

BackgroundReproductive health is the core science of human life and is critical to the healthy and sustainable development of human society. Since 1980, China has enforced a “one child” policy. With the implementation of the Universal Two-Child Policy in 2016, every couple is allowed to have two children instead of one, which will lead to more pregnancies, births, and advanced maternal age. Thus, women aged 20–39 years, at the peak of sexual activity and fertility, will face more reproductive health problems related to pregnancies and births. This study aimed to investigate the current reproductive health status, knowledge, and factors associated with reproductive health knowledge among women aged 20–39 years in rural China.MethodsA cross-sectional study was conducted in five villages of five cities in China. The data were collected using pre-tested and structured questionnaires through face-to-face interviews. The data were entered into Epidata version 3.0, and analyzed using SPSS version 18.0. A descriptive summary of the data and logistic regression were used to identify associated factors.ResultsOne-third of the participants reported that they had suffered from gynecopathy, and 38.89% of participants with gynecopathy-related discomfort did not seek medical treatment. Condoms and intrauterine devices were the main contraceptive measures used, and 28.70% of women had a history of induced abortion. Over half of the respondents (53.00%) were classified as having a low reproductive health knowledge score. Factors associated with lower knowledge levels were lower education, no history of gynecopathy, and lack of acquiring knowledge from medical staff, WeChat/micro-blog, or the internet.ConclusionA poor reproductive health situation and low level of health knowledge were found among women aged 20–39 years in rural China. More specific interventions promoting reproductive health and targeting rural women aged 20–39 years are needed.

How does the two-child policy affect the sex ratio at birth in China? A cross-sectional study

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.

Related Factors of Turnover Intention Among Pediatric Nurses in Mainland China: A Structural Equation Modeling Analysis

PurposePediatric nurses are at high risk for turnover. Turnover intention strongly predicts the actual voluntary turnover. Currently, no nationwide study has examined turnover intention among pediatric nurses in mainland China since the universal two-child policy implementation. Related factors associated with pediatric nurse turnover intention have not yet been identified. This study aims to understand factors related to turnover intention among pediatric nurses in mainland China. Design and methodsA cross-sectional on-line questionnaire survey was conducted among 6673 pediatric nurses across mainland China. Structural equation modeling (SEM) was used to examine the relationships between job satisfaction, work stress, job burnout, organizational commitment, work-family support and turnover intention. ResultsSix hundred and sixty-three (9.93%) nurses reported high turnover intention. Work stress and job burnout were directly and indirectly associated with turnover intention positively. Job satisfaction was related to turnover intention negatively with both direct effect and indirect effect through the mediations of job burnout and organizational commitment. Organizational commitment had a negative direct effect on turnover intention. Work-family support had indirect effects on turnover intention through the mediating role of burnout, job satisfaction, and organizational commitment. ConclusionTurnover intention among pediatric nurses was associated with job satisfaction, work stress, job burnout, organizational commitment and work-family support. Practice implicationsAttention to pediatric nurses' job burnout and work stress is important to improve job satisfaction and organizational commitment and to provide them with support in order to alleviate the turnover intention.

The impact of fertility policy on the actuarial balance of China’s urban employee basic medical insurance fund–The selective two-child policy vs. the universal two-child policy

This study aims to investigate the impact of the change in China’s fertility policy from its selective two-child policy to a universal two-child policy on the balance of its Urban Employee Basic Medical Insurance (UEBMI) fund. This study uses data obtained from the 2013 and 2015 China General Society Survey to estimate the Poisson model, and then adopts a bisexual Leslie matrix, estimated adjusted coefficients, and an actuarial model to forecast the current balance and accumulated balance of the UEBMI fund under each of the selective two-child and universal two-child policies up to the year 2060. The primary finding of this study is that this change in fertility policy results in the current balance of the UEBMI fund registering a lower deficit and eventually a surplus. Although this policy change cannot prevent the UEBMI from facing bankruptcy, the deficit in terms of the accumulated balance of the UEBMI fund will decline.

Second-birth fertility desire and social factors in married women in Zhejiang province, China: A cross-sectional study

After the universal two-child policy in China, the Second-Birth Fertility Desire (SBFD) has aroused widespread concern. There have been some research on SBFD, however, current reports on social factors and SBFD are not detailed.

Fertility intention and related factors in China: findings from the 2017 National Fertility Survey

This paper reports the fertility intension of women based on data from the national fertility survey in 2017 in China (CFS 2017), after implementation of the universal two-child policy, and analyses major related factors. The reported ideal number of children is 1.96 in average, and the intended number of children is 1.76, with obvious differences among different regions. The ideal number of children is highly correlated with the intended number of children, and intended number of children is related to number of children women already have. Women who have had one child intend to have fewer children than women who have not yet had a child. Women who have not yet had any child intend to have 1.60 children in average. The preference of boy varies by intended number of children.

Associations between prenatal exposure to fine particulate matter and birth weight and modifying effects of birth order related to a new baby boom: A prospective birth cohort study in Guangzhou, China

Abstract Although studies have assessed the associations between prenatal exposure with fine particulate matter (PM) with birth weight, few have investigated the effect of PM1 exposure and identified the susceptible exposure window. Additionally, a baby boom occurred after China implemented the universal two-child policy, but whether the effects of PM are modified by birth order remains unknown. The objective of this study was to estimate the effects of prenatal exposure to PM (PM2.5 and PM1) on birth weight, identify the susceptible exposure windows, and assess the modifying effect of birth order on the effects of PM exposure. All participants were selected from the Prenatal Environment and Offspring Health (PEOH) cohort conducted since 2016 in Guangzhou, China. A spatiotemporal land–use-regression (STLUR) model was used to estimate a pregnant woman's weekly PM2.5 exposure, and a generalized additive model (GAM) was used to estimate each PM1 exposure. A distributed lag non-linear model (DLNM) was applied to assess the exposure–lag-response associations between weekly PM exposure and birth weight. The sample included 4086 pregnant women. The results showed that maternal exposure to PM2.5 and PM1 during the 15th to 24th and 16th to 24th gestational weeks were associated with lower birth weight, the strongest association was observed in the 19th week, during which each 10 μg/m3 increment in PM2.5 and PM1 was associated with a 1.47 g (95% CI: 2.49 g, 0.44 g) and 1.58 g (95%CI: 2.74 g, 0.41 g) decrease in birth weight, respectively. Compared with the first-born neonates, greater effects of PM2.5 and PM1 exposure on birth weight were observed among the second-born neonates in the 15th to 21st and 15 h to 22nd gestational weeks. Further studies tracking the health of the second-born children are warranted because they may be more sensitive to environmental factors than the first-born children.

Evaluating the Impacts of Universal Two-Child Policy on Beijing’s Population

This paper explores the impacts of the universal two-child policy on Beijing’s population in the long term. It gives a detail estimation of Beijing population considering the latest fertility and immigration policy and can help related government department management population. The cohort-component method based on a net migration was applied to project population by age for Beijing from 2020 to 2050 in four fertility scenarios. The innovation is the estimation method of the mortality rate with the life table linked with life expectancy. The results show that, though the basic development trend of Beijing’s population will not change essentially under the universal two-child policy, low birth rate and aging problems will be improved. Compared with the partial policy relaxation, the total population will be 876,478 persons more than that in 2050, the share of population aged 0–14 will increase 1.1 percentage points, and the aged dependency ratio will decrease 1.96 percentage points. Some measures should be taken to encourage more couples to have a second child and introduce more young talents to promote Beijing’s prosperity.

Effect of China's Universal Two-child Policy on the Rate of Cesarean Delivery: A Case Study of a Big Childbirth Center in China.

China's universal two-child policy was released in October of 2015. How would this new policy influence the rate of overall cesarean delivery (CD) in China? The objective of this paper is to investigate the trend of overall CD rate with the increase of number of multiparous women based on a big childbirth center of China (a tertiary hospital) in 2016. In this study, 22 530 cases from the medical record department of a big childbirth center of China from January 1 to December 31 in 2016 were enrolled as research objects. Electronic health records of these selected objects were retrieved. According to the history of childbirth, the selected cases were divided into primiparous group containing 16 340 cases and multiparous group containing 6190 cases. Chi-square test was carried out to compare the rate of CD, neuraxial labor analgesia, maternity insurance between the two groups; t-test was performed to compare the in-hospital days and gestational age at birth between the two groups. Pearson correlation coefficient was used to evaluate the relationship among observed monthly rate of multiparas, overall CD rate, and Elective Repeat Cesarean Delivery (ERCD) rate. The results showed that the CD rate in multiparous group was 55.46%, which was higher than that in primiparous group (34.66%, P<0.05). The rate of neuraxial labor analgesia in multiparas group was 9.29%, which was lower than that in primiparas group (35.94%, P<0.05). However, the rate of maternity insurance was higher in multiparas group (57.00%) than that in primiparas group (41.08%, P<0.05). The hospital cost and in-hospital days in multiparas group were higher, and the gestational age at birth in multiparas group was lower than in primiparas group (P<0.05). The overall CD rate slightly dropped in the first 4 months of the year (P<0.05), then increased from 36.27% (April) to 43.21% (December) (P<0.05). The rate of multiparas women and ERCD had the same trend (P<0.05). There were linear correlations among the rate of overall CD, the rate of multiparas women and the rate of ERCD rate (P<0.05). With the opening of China's two-child policy, the increasing rate of overall CD is directly related with the high rate of ERCD. Trials of Labor After Cesarean Section (TOLAC) in safe mode to reduce overall CD rate are warranted in the future.

Obstetric anesthesia in China: associated challenges and long-term goals.

Obstetric anesthesia in China: associated challenges and long-term goals.

Changes in maternal age and prevalence of congenital anomalies during the enactment of China's universal two-child policy (2013–2017) in Zhejiang Province, China: An observational study

BackgroundChina implemented a partial two-child policy (2013) followed by a universal two-child policy (2015), replacing the former one-child policy mandated by the government. The changes affect many aspects of China’s population as well as maternal and infant health, but their potential impact on birth defects (BDs) remains unknown. In this study, we investigated the associations of these policy changes with BDs in Zhejiang Province, China.Methods and findingsWe used data from the BD surveillance system in Zhejiang Province, China, which covers 90 hospitals in 30 urban districts and rural counties, capturing one-third of the total births in this province. To fully consider the time interval between conception and delivery, we defined the one-child policy period as data from 2013 (births from October 2012 to September 2013), the partial two-child policy period as data from 2015 (births from October 2014 to September 2015), and the universal two-child policy period as data from 2017 (births from October 2016 to September 2017). Data from 2009 and 2011 were also used to show the changes in the proportion of births to women with advanced maternal age (35 years and older) prior to the policy changes. Main outcome measures were changes in the proportion of mothers with advanced maternal age, prevalence of BDs, rankings of BD subtypes by prevalence, prenatal diagnosis rate, and live birth rate of BDs over time. A total of 1,260,684 births (including live births, early fetal losses, stillbirths, and early neonatal deaths) were included in the analyses. Of these, 644,973 (51.16%) births were to women from urban areas, and 615,711 (48.84%) births were to women from rural areas. In total, 135,543 (10.75%) births were to women with advanced maternal age. The proportion increased by 85.68%, from 8.52% in 2013 to 15.82% in 2017. However, it had remained stable prior to policy changes. Overall, 23,095 BDs were identified over the policy changes (2013–2017). The prevalence of BDs during 2013, 2015, and 2017 was 245.95, 264.86, and 304.36 per 10,000 births, respectively. Trisomy 21 and other chromosomal defects increased in both risk and ranking from 2013 to 2017 (crude odds ratio [95% confidence interval] 2.13 [1.75–2.60], from ranking 10th to 5th, and 3.63 [2.84–4.69], from ranking 16th to 6th, respectively). The prenatal diagnosis rate increased by 3.63 (2.2–5.1) percentage points (P < 0.001), from 31.10% to 34.72%, and identification of BDs occurred 1.88 (1.81–1.95) weeks earlier (P < 0.001). The live birth rate for infants with BDs born before 28 gestational weeks increased from 1.29% to 11.45%. The major limitations of this observational study include an inability to establish causality and the possible existence of unknown confounding factors, some of which could contribute to BDs.ConclusionsIn this study, we observed significant increases in maternal age and the prevalence of total and age-related anomalies following China’s new two-child policy. Increases in live birth rate for infants with BDs born before 28 gestational weeks suggest that healthcare for very preterm births with BDs may be warranted in the future, as well as updating the definition of perinatal period.

Assessing the impact of C-section at first birth on the second birth

Taking data from the China Fertility Survey 2017 for nine provinces in southwestern and south-central China, we calculated differences in C-section rates among women of different ages, and with different types of hukou and different levels of education. We used the Cox proportional hazards model and a binary logistic regression method to examine the impact of C-section at the first birth on the intention of having a second child and actually giving birth to a second child under the Universal Two-child Policy. This study comes to the following conclusions: (1) the C-section rate is generally high among women, especially among those who are older, have non-agricultural hukou, or have a junior college or above education level; (2) similar to the research findings of scholars in other countries, women having C-section at first birth are 16–20% less likely to have a second child than women having no C-section at first birth; and (3) women having C-section at first birth are less inclined to have a second child.

The impact of child births on female labor force participation in China

Adjustments to fertility policy in recent years have led to changes in fertility level and these have had an impact on the overall population and have implications for labor force participation. In particular, fertility policy adjustments have had a direct influence on the female labor force. This paper uses data from China Family Panel Studies in 2016 to test the impact that increases in the number of child births that have occurred as result of shifts in fertility level are having on women’s labor force participation. Our findings show that the influence of the number of children on the participation of married women in the labor force is shown by a “U-shaped” non-linear relationship dominated by substitution effect and income effect. The turning point of urban married women from the substitution effect to the income effect occurs earlier than it does for rural married women. This means that urban married women are more sensitive to the economic pressure that results from child births. Therefore, the Universal Two-Child policy, introduced at the beginning of 2016, inevitably has a direct negative effect on women’s labor force participation. Helping women to maintain work-family balance has become a problem that must be addressed at present.

Parental Investment After the Birth of a Sibling: The Effect of Family Size in Low-Fertility China

A large body of research has examined the relationship between family size and child well-being in developing countries, but most of this literature has focused on the consequences of high fertility. The impact of family size in a low-fertility developing country context remains unknown, even though more developing countries are expected to reach below-replacement fertility levels. Set in China between 2010 and 2016, this study examines whether an increase in family size reduces parental investment received by the firstborn child. Using data from the China Family Panel Studies (CFPS), this study improves on previous research by using direct measures of parental investment, including monetary and nonmonetary investment, and distinguishing household-level from child-specific resources. It also exploits the longitudinal nature of the CFPS to mediate the bias arising from the joint determination of family size and parental investment. Results show that having a younger sibling significantly reduces the average household expenditure per capita. It also directly reduces parental investment in the firstborn child, with two exceptions: (1) for firstborn boys, having a younger sister does not pose any competition; and (2) for firstborn children whose mothers have completed primary education or more, having a younger brother does not reduce parental educational aspirations for them. Findings from this study provide the first glimpse into how children fare as China transitions to a universal two-child policy regime but have wider implications beyond the Chinese context.

A Survey on the Continuing Education Status and Demand of Nurses in Chongqing Grass-Root Medical Institutions

Background: With the increased aging of population, the continuous increase in the morbidity of chronic diseases, and the issuance of universal two-child policy, the grass-root medical teams become more and more important. Objective: To investigate the continuing education status and demand of nurses in the grass-root medical institutions and thus provide a reference for optimizing the continuing education plan. Methods: From October 2018 to May 2019, a survey of 270 nurses from 28 grass-root medical institutions in Tongliang District of Chongqing was performed using a self-designed questionnaire. Results: In the grass-root medical institutions, the major continuing education pattern of nurses was hospital training and distance education; the continuing education focused on new basic theoretical knowledge and new nursing techniques, and its satisfaction was 67.8%. About 20.6% questionnaire answerers never had received continuing nursing education. As shown by one-way analysis of variance (ANOVA) and binary logistic regression analysis, the following factors were associated with the continuing education participation in the past three years: work unit, organizational affiliation, age, professional title and hospital policies. There were 93.0% questionnaire answerers reflecting that it was necessary to participate in the continuing education and wishing the conformance between the pattern and contents of continuing nursing education and the actual implementation status. Conclusion: The continuing education demand of nurses in the grass-root medical institutions is basic but diverse, and the organizations shall provide effective policy support for continuing education and make the diversified training plan by combining Internet technology, so as to realize the maximization of continuing education participation and keep improving the overall service quality of gross-root nurses.

Interventions to reduce the cesarean delivery rate in a tertiary hospital in China

Introduction High cesarean delivery rate has been a global public health concern. This study assesses the effect of medical interventions and societal changes on cesarean delivery rates in a Chinese tertiary hospital. Material and methods A retrospective study including all live births ≥34-week gestation between 2008 and 2016 from Guangzhou Women and Children’s Medical Center was divided into 5 stages: (1) no interventions; (2) patient-controlled epidural analgesia; (3) episiotomy restriction; (4) new labor management; (5) universal two-child policy. An interrupted time series design was used to measure the effect of interventions on overall cesarean rate, primary cesarean rate, maternal and neonatal outcomes. Results There were 126,609 deliveries including 49,092 cesarean deliveries and 77,517 vaginal deliveries in this period. Overall cesarean delivery rate declined after implementing patient-controlled epidural analgesia, episiotomy restriction and universal two-child policy. Primary cesarean rate decreased after implementing episiotomy restriction. Cesarean rate with previous cesarean dramatically increased, and maternal request cesarean rate decreased gradually. Low Apgar rate (score ≤7 at 5 min) increased after episiotomy restriction and maternal postpartum hemorrhage rate increased after new labor management. Conclusions Patient-controlled epidural analgesia, episiotomy restriction and the universal two-child policy showed the most significant effects to reducing the cesarean rate.

Should We Have a Second Child? Reproductive Decisions and Family Negotiation under China’s Two-child Policy

ABSTRACT Although China has implemented a universal two-child policy to increase its low fertility rate, many Chinese couples still hesitate over having a second child. The existing literature focuses on how various factors affect reproductive decision-making in different social contexts, paying less attention to family dynamics and intra-family negotiation in the process of reproductive decision-making. Drawing on qualitative data obtained from 53 urban parents in China, this study enriches the discussion by examining how the decision of whether to have a second child is negotiated among multiple family members. Applying the interpretive perspective, this study analyzes the narratives, actions and tactics of family members with conflicting reproductive preferences and reveals how they shape each other’s reproductive decisions in the dynamic process of intra-family negotiation. It sheds new light on the reproductive politics in urban Chinese families by focusing on how the two-child policy is negotiated and contested at the micro-level and by highlighting the complexity and fluidity of the relational process of reproductive decision-making.

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.

Influencing factors and correlation of anxiety, psychological stress sources, and psychological capital among women pregnant with a second child in Guangdong and Shandong Province

BackgroundAfter the one-child policy has been effective for over 30 years, China implemented the universal two-child policy in 2015. The number of high-risk pregnant women had increased dramatically ever since, increasing negative health outcomes for both mothers and children. Our study aims to investigate the status of anxiety, psychological stress sources, and psychological capital among women pregnant with a second child, and to assess influencing factors and correlations, providing scientific basis for promoting women's health during pregnancy. MethodsWe recruited 513 participants from maternity hospitals in Guangdong and Shandong Province. All participants completed the Zung Self-Rating Anxiety Scale (SAS), Pregnant women psychological stress sources questionnaire and the psychological capital questionnaire (PCQ-24). ResultsThe prevalence of anxiety of women pregnant with a second child was 27.5%. The score of psychological stress sources was 74.93 ± 16.07. The risk factors for the anxiety of the women pregnant with a second child included low education level of the husband, gender expectation and the sources of psychological stress of the pregnant woman. The risk factors for psychological stress were dissatisfaction of residence and unplanned pregnancy. The main factors influencing psychological capital were the participants’ education level, whether they have learned antenatal care knowledge and satisfaction with the residence. LimitationsAll participants were recruited only from tertiary hospitals in Guangdong and Shandong province. ConclusionsAnxiety and psychological stress is prevalent during pregnancy among women pregnant with a second child in Guangdong and Shandong. Psychological capital was a protective factor for anxiety.