Peer-reviewed article
Fertility intention and its determinants of childbearing-age population in China after the three-child policy: a systematic review and meta-analysis.
Ren J, Zhou X, Zheng Y, Ye X, Hu L et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis examines fertility intentions among childbearing-age adults in China following the introduction of the three-child policy. The study synthesises 37 research papers involving over 113,000 participants to identify what factors influence whether people intend to have a third child or additional children. The findings show that fertility intentions remain low overall, with only 7.6% intending to have a third child and 12.7% willing to have another child.
Key points
- Pooled prevalence of third-child fertility intention was 7.6% and willingness to have another child was 12.7% across 37 studies
- Factors associated with higher third-child fertility intention included age over 35, male sex, lower education level, higher monthly income, ethnic minority status, and having a non-only-child spouse
- Remarriage and good self-assessed health were significant determinants of willingness to have additional children
- The review suggests that childcare subsidies, medical security, and addressing housing and education costs may help raise fertility intentions
- The study notes that both third-child fertility intention and general willingness to have another child remain low in China's childbearing-age population
Limitations
This systematic review examines adult fertility intentions rather than child well-being outcomes. It does not evaluate any intervention to improve children's health, development, protection or participation, nor does it measure impacts on actual child welfare.
Abstract
Background China's sustained fertility decline has intensified population contraction and ageing. Following the rollout of the three-child policy, clarifying fertility intentions among the childbearing-age population and their determinants is crucial for effective policy design and fertility promotion. Methods We conducted a systematic search of PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and Chinese Biomedical Literature Database. We included in the analysis studies published from 31 May 2021 to 10 May 2025 that examined third-child fertility intention (TCFI) and its determinants among the childbearing-age population in China. We used the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies to assess the quality of studies. Further, we estimated pooled prevalence with random-effects models. Results A total of 37 studies were included in the analysis (n = 113 009 participants). The pooled prevalence of TCFI and willingness to have another child (WHAC) were 7.6% and 12.7%. Factors associated with higher TCFI included age >35 years, male sex, education at or below high school level, monthly personal income >CNY 2000, ethnic minority status, having at least one non-only-child spouse, and having no pension insurance. For WHAC, remarriage and good self-assessed health were significant determinants. Conclusions Both TCFI and WHAC remain low in China's childbearing-age population. Enhancing childcare subsidies, strengthening medical security, and addressing core economic constraints such as housing and education may help raise fertility intentions. Registration PROSPERO: CRD420251036086.