Birth experiences of urban women of advanced age having their second child after introduction of the universal two-child policy in China: A qualitative study

AbstractBackgroundInfertility has become an important issue in modern world because of the increasing number of infertile couples around the world. Advanced maternal age was considered to be a main factor of infertile problem. With second child policy published in China and more women in China intend to seek help for infertility problem, this study provided information of fertility diagnostic factors and IVF treatment outcomes of female IVF patients in different age groups, which can be a guidance for infertility diagnostic and treatment.MethodsA retrospective cohort study was conducted to IVF patient data collected by Jinjiang District Maternal and Child Health Hospital, Chengdu, China. Clinical and laboratory data of 45,743 fresh, autologous IVF cycles from January 2008 to September 2017 were included in the analysis. The diagnostic factors and treatment outcomes were analyzed for different age groups (age<35, n=30,708; age 35-41, n=11,921 and age≥42, n=3,114) as well as further stratified advanced age groups (age 42, n=933; age 43, n=744; age 44, n=556; age≥45, n=881). The characteristics including number of previous cycles, duration of infertility, BMI, basic FSH, basic AFC, AMH, retrieved oocyte number, fertilized oocyte number, transferred embryo number, baby number and economic cost were stratified according to patient age.ResultsThe basic characteristics of obesity rate, basic FSH and cancellation rate of IVF cycles in ≥42 years old group were significantly higher than other groups (p<0.01). Basic AFC, AMH, retrieved oocyte number, fertilized oocyte number and transferred embryo number in ≥42 years old group were significantly lower than other groups (p<0.01). Diagnostics characteristics and IVF-ET outcome declined significantly when maternal age increased (p<0.05). In the meanwhile, a preliminary analysis of cost per cycle showed that cost per child increased with patient’s age increase.ConclusionAlthough with increasing number of advanced maternal age IVF cycles, the age group of ≥42 years would intend to get unsatisfied outcome and higher cost per child. More guidance and considerations should be focused on encouraging earlier age treatment of infertility.Plain English summaryWith more and more women in the global range choose to get late pregnancy because of changes in society and economy, age has become an unavoidable factor in infertility diagnostic and treatment. Advanced age women may experience more infertility problems and negative IVF outcomes. A better understanding of the effect of maternal age on infertility would offer help to both diagnostic and treatment of IVF patient. This study conducted a single-center retrospective cohort analysis to female patients of different age groups and found that women with more advanced age (≥42) would be more easily to experience unsatisfied IVF outcome and higher economic cost to obtain one child. After the publication of second child policy in China in 2013, the number of advanced age patients increased, the necessity of special guidance for AMA patient may need to be taken into consideration.

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The second pregnancy has no effect in the incidence of macrosomia: a cross-sectional survey in two western Chinese regions

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00244-z ◽

2021 ◽

Vol 40 (1) ◽

Author(s):

Li Luo ◽

Huan Zeng ◽

Mao Zeng ◽

Xueqing Liu ◽

Xianglong Xu ◽

...

Keyword(s):

Logistic Regression ◽

Western China ◽

Fetal Macrosomia ◽

Multivariate Logistic Regression Model ◽

Multivariate Logistic Regression ◽

Cross Sectional ◽

Second Child ◽

Child Policy ◽

Significant Difference ◽

The Impact

Abstract Background After the implementation of the universal two-child policy in China, the increase in parity has led to an increase in adverse pregnancy outcomes. The impact of one and two fetuses on the incidence of fetal macrosomia has not been fully confirmed in China. This study aimed to explore the differences in the incidence of fetal macrosomia in first and second pregnancies in Western China after the implementation of the universal two-child policy. Methods A total of 1598 pregnant women from three hospitals were investigated by means of a cross-sectional study from August 2017 to January 2018. Participants were recruited by convenience and divided into first and second pregnancy groups. These groups included 1094 primiparas and 504 women giving birth to their second child. Univariate and multivariate logistic regression analyses were performed to discuss the differences in the incidence of fetal macrosomia in first and second pregnancies. Results No significant difference was found in the incidence of macrosomia in the first pregnancy group (7.2%) and the second pregnancy group (7.1%). In the second-time pregnant mothers, no significant association was found between the macrosomia of the second child (5.5%) and that of the first child (4.7%). The multivariate logistic regression model showed that mothers older than 30 years are not likely to give birth to children with macrosomia (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4,0.9). Conclusions The incidence of macrosomia in Western China is might not be affected by the birth of the second child and is not increased by low parity.

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Fertility intentions among the working population of Dalian City born between 1980 and 1989

Journal of Biosocial Science ◽

10.1017/s0021932021000213 ◽

2021 ◽

pp. 1-12

Author(s):

Hongyan Qiu ◽

Qun Zhang ◽

Jin Zhang ◽

Qingshan Wang ◽

Lihong Liu ◽

...

Keyword(s):

Family Income ◽

Reproductive Behaviour ◽

Fertility Intentions ◽

Second Child ◽

Number Of Children ◽

Child Policy ◽

Future Fertility ◽

The Future ◽

Dalian City ◽

Ideal Number

Abstract In October 2015, the Chinese Government announced that the one-child policy had finally been replaced by a universal two-child policy. China’s universal two-child policy is highly significant because, for the first time in 36 years, no one in an urban city is restricted to having just one child. This cross-sectional study was conducted to explore future fertility intentions and factors influencing individual reproductive behaviour (whether to have two children) in Dalian City. A total of 1370 respondents were interviewed. The respondents’ mean ideal number of children was only 1.73, and urban respondents’ sex preference was symmetrical. A total of 19.0% of the respondents were unmarried, 64.5% were married and had childbearing experience and only 6.3% of married respondents had two children. Among the 1370 participants, 30.4% stated that they would have a second child, while 69.6% refused to have a second child in the future. Binary logistic regression analysis (Model 1) showed that the following characteristics were associated with having only one child in the future: being female, being older, having a lower education level, being born in Dalian, having a lower family income and reporting one child as the ideal number of children. Model 2 (comprising only respondents with childbearing experience) showed that respondents who were female, had a lower family income and were unable to obtain additional financial support from parents were more likely to intend to stick at one child. In addition, respondents’ ideal number of children and childbearing experiences had a significant influence on future fertility intentions. These results suggest that fertility intentions and reproductive behaviours are still below those needed for replacement level fertility in Dalian City. China’s policymakers should pay more attention to these factors (socioeconomic characteristics, economic factors, desired number of children and childbearing experiences) and try to increase individual reproductive behaviour.

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