Peer-reviewed article

Exploration of childcare service for children aged 0-3 in Eastern China: a cross-sectional study.

Jun Wang, Yihan Ma, Hui Huang, Yan Chen, Xinyao Ju · 28 Feb 2026

Abstract

BACKGROUND: In recent years, China has experienced a continued decline in fertility rates alongside accelerated population aging, raising widespread concerns about socioeconomic sustainability. Accessible, affordable, and well-matched childcare services can help promote fertility. Therefore, improving the uptake of childcare services represents an important measure for enhancing fertility and is of great significance to China. This study examines the supply and demand dynamics and influencing factors of childcare services for children aged 0–3 in eastern China, providing a foundation for optimizing such services. DESIGN: This cross-sectional study used multistage probability-proportional-to-size sampling. Fourteen subdistricts were randomly selected, followed by community sampling weighted by the under-three population, and simple random sampling of households. The final sample included 1,754 households with children aged 0–3 years. METHODS: Data were collected via an online survey from March 14 to May 15, 2024, accessed through a QR code. All investigators completed protocol training, and quality control procedures were implemented. The response rate was 60.23%, with no significant non-response bias. The questionnaire captured childcare enrollment, demand, preferences, and barriers. Analyses identified determinants of service use. RESULTS: Overall, 26.68% of households had used childcare services in the past three years. Among those without prior experience, 51.79% planned to use services within the next year. Key predictors of service use included higher maternal education, stable employment, and having more children. Families consistently prioritized institutional safety and environment (82.37%) and staff qualifications (77.36%), showing a clear preference for non-private childcare (75.83%). Among households using or planning to use services, public preschool-affiliated classes were the most preferred type of provision. Full-day care was the dominant preferred format (64.23%), though partial-day and occasional care were also notable. The primary barrier to use was concern over safety and supervision (77.51%), whereas cost appeared less prohibitive, with 83.52% of respondents finding monthly fees under 3,000 CNY acceptable. CONCLUSION: Initial policy efforts have improved access to childcare, yet critical gaps in safety regulation and public trust persist. Future policies should systematically invest in trust-building, accurately identify and respond to regional variations in the provision of “enabling resources” and household “predisposing characteristics,” and implement more locally adaptive support strategies.