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Background: Fertility intentions, as a direct driver of fertility behavior, play an important role in the implementation of national fertility policy and population development. This study explored the influencing factors of college teachers' second child fertility intentions in Jinan, China on the basis of TPB. Methodology/Principal findings: Based on the theory of planned behavior, this paper employs basic characteristics analysis, difference analysis, and factor analysis related to the fertility intentions of the participants. Analysis found participants between 31 and 40 years old had the highest second child fertility intentions, and participants with a college-age first child had the lowest second child fertility intentions. Attitude and subjective norms had a positive impact on second child fertility intentions, and policy awareness had a positive impact on attitude, which indirectly affected second child fertility intentions. Subjective norms had the greatest influence on second child fertility intentions, followed by attitude, and policy awareness had the least influence on second child fertility intentions. Significance/Future research: The findings of this paper can enrich the theoretical research on fertility intentions, and also provide more optimal practical references for the formulation and propagation of China's fertility policy as well as the improvement of the division of family roles in China. Future research can further explore the impact of fertility policy on the fertility intentions of other groups. [ABSTRACT FROM AUTHOR]

Background: Against the grim background of declining intention to have children, the ravages of COVID-19 have pushed China and the world into a more complex social environment. To adapt to the new situation, the Chinese government implemented the three-child policy in 2021. Objective: COVID-19 pandemic indirectly affects the country's internal economic development, employment, fertility plans or intention, and other major issues related to the people's livelihood, while undermining the stable operation of society. This paper explores the question that will COVID-19 pandemic affect Chinese people's intention to have a third child. And What are the relevant factors inside? Method: The data in this paper are from the Survey released by the Population Policy and Development Research Center of Chongqing Technology and Business University (PDPR-CTBU), including 10,323 samples from mainland China. This paper uses the logit regression model and KHB mediated effect model (a binary response model given by Karlson, Holm, and Breen) to investigate the impact of the COVID-19 pandemic and other factors on Chinese residents' intention to have a third child. Results: The results suggest that the COVID-19 pandemic has a negative effect on Chinese residents' intention to have a third child. In-depth research on the mediating effect of KHB shows that COVID-19 pandemic will further inhibit residents' intention to have a third child by affecting their childcare arrangements, increasing their childcare costs, and increasing their exposure to occupational hazards. Contribution: This paper is more pioneering in focusing on the impact of the COVID-19 epidemic on the intention to have three children in China. The study provides empirical evidence for understanding the impact of COVID-19 epidemic on fertility intentions, albeit in the context of policy support. [ABSTRACT FROM AUTHOR]

In response to the population aging, on May 31, 2021, the Political Bureau of the Central Committee of the Communist Party of China (CPC) proposed the policy that a couple can have three children and rolled out more supportive measures to further optimize fertility policies, which is another major initiative following the universal two-child policy introduced in November 2015. Currently, a series of population policy innovations have aroused great attractions among the public and triggered a hot debating on the Internet. People’s fertility attitude tendency under different related policies can reflect their current fertility intentions. Based on the fact, this paper firstly classifies the sentiment of online comment data on the three-child policy and analyzes people’s sentiment tendency toward the three-child policy from the spatio-temporal perspectives. Secondly, people’s points of view on the three-child policy are summarized by using Latent Dirichlet Allocation (LDA) thematic clustering. The reasons for the change in people’s fertility attitude tendency under different fertility policies are analyzed by comparing the change in people’s fertility attitude tendency with the change in people’s attentions. Finally, a multiple regression equation is constructed to analyze the key factors influencing people’s intention to have three children by using public opinion data and its extension data. The findings demonstrate: (1) people’s fertility attitudes toward the three-child policy are negative and similar among different regions; (2) compared to the two-child policy, the percentage of negative and neutral attitudes toward the three-child policy increases, while the percentage of positive attitudes decreases; (3) the increase in fertility costs, the deterioration of women’s employment environment, and the change in the concept of marriage and childbirth become important reasons for the negative change in people’s fertility attitudes toward different policies. Therefore, the government should take measures to reduce the burden of childbirth and guide the correct concept of marriage and childbirth to improve people’s fertility intentions. [ABSTRACT FROM AUTHOR]

On 31 May 2021, the Political Bureau of the Central Committee of the Communist Party of China proposed the policy that a couple can have three children, and rolled out more supportive measures to further optimize the fertility policies. However, while the Chinese government is further optimizing its fertility policy, the sudden outbreak of COVID-19 is raging around the world, which threatens the implementation of China's fertility optimization policy. Based on this, this paper firstly explores the impact of COVID-19 on women's fertility intentions. Secondly, based on the Theory of Planned Behavior, this paper constructs a structural equation model to quantitatively reveal the specific factors that affect women's fertility intentions under the epidemic, as well as their impact paths, and then puts forward corresponding suggestions for the government to solve the problem of fertility, aiming at delaying population aging and optimizing population structure. The research results show that: (1) COVID-19 lowers the fertility intentions of women of childbearing age. (2) During the pandemic, economic pressure emerged as the biggest factor affecting women's fertility intentions. The decline in income caused by the pandemic has become an important factor in preventing women from having children. (3) The conflict between work and childbearing is still an important factor affecting the fertility intentions of women of childbearing age. The government's provision of perfect childcare services and their strengthening of the protection of women's employment rights and interests will greatly reduce women's anxiety about childbearing. [ABSTRACT FROM AUTHOR]

As China continues to implement its progressive fertility promotion policy, there has been a drastic decline in the fertility rate. Given that the migrant population constitutes more than a quarter of China's total population, enhancing the willingness of this demographic to have additional children through policy-guided urban public services is pivotal for optimizing China's population development strategy. This study analyzes the influence of urban public services on the reproductive intentions of the migrant population, utilizing data from 110,667 migrant families with one child, drawn from China's Migrant Population Dynamic Monitoring data in 2016 and 2018. The data analysis reveals several key findings: (1) Urban public services, overall, exhibit a notable positive effect on the willingness of the migrant population to have more children, albeit with limitations and a declining trend. (2) Among urban public services, primary basic education significantly impacts the willingness of the migrant population to expand their families. (3) Large cities have created a 'reverse screening' effect on the migrant population, leading to differential access to public services. This scenario caters effectively to the high human capital migrant individuals while reducing accessibility to livelihood public services for the low human capital migrant population. This paper critically evaluates China's progressively adjusted fertility policy from the perspective of the migrant population. It underscores the necessity of establishing a comprehensive fertility support policy system across China. [ABSTRACT FROM AUTHOR]

Although the Chinese government has shifted from a one-child policy to a two-child policy (allowing a couple to have up to two children) since 2016 in response to the aging population, the policy results have been unsatisfactory. This is the first paper to systematically investigate the factors influencing residents' intentions to have a second child. The research focuses on the perspective of individual, family, and social characteristics based on the Chinese General Social Survey (CGSS) from 2017 to 2018. Three machine learning methods are used in conjunction with logistic regression to reveal that the intention of having a second child increases heavily with age, more siblings in the family of origin, and better health. The family income, which is currently the focus of the literature and is statistically significant, is only sixth most important. This study further reveals differences between genders: Women with a lower level of education and religious beliefs prefer to have a second child, whereas for men, non-agricultural hukou and marriage are the position factors. The results of this study also illustrate the importance of future research focusing on the relationship of individuals to their family of origin and districts. [ABSTRACT FROM AUTHOR]

There is continuing debate on how low China's fertility has reached and whether China has fallen into the "low fertility trap". This paper addresses this debate by revisiting the trends in fertility preferences in the past decades in China based on a meta review. Moreover, the analysis contrasts distinct measurements of fertility preferences to capture different aspects of reproductive decision-making. This papers reviews 152 studies resulting in 137 estimates for the mean of preferred number of children, 104 estimates for the proportions of different numbers of children preferred and 66 estimates for the second-child preferences. We found that after the long-time decline of fertility preferences in the last century, the average family size remained at a low level but started to increase slowly since 2001. This upturn was observed for all three types of measurements of fertility preferences: ideal, desired, and planned family size. The results also indicate a strong two-child preference (more than 50% of respondents) in China, although 30% of people prefer one child and only a small fraction indicating an ideal family size for three or more children. Results on people's preference for a second child were less consistent. We concluded that fertility is unlikely to increase rapidly in China even when the government adopts more relaxed family planning policy. Because the upward trend in fertility preferences was very minimal and the economic constraints will prevent many people to realise their preferences. [ABSTRACT FROM AUTHOR]

This paper examines the impact of house prices on floating populations' fertility intentions in China. Specifically, this is among the first studies to distinguish between urban-to-urban and rural-to-urban migrants. Using data from the Chinese General Social Survey (CGSS), the results indicate that higher house prices discourage urban-to-urban migrants' fertility intentions but do not significantly affect rural-to-urban migrants' fertility intentions. Moreover, among urban-to-urban migrants, homeowners and those with higher levels of education are more adversely affected by higher house prices. Potential mechanisms are discussed. [ABSTRACT FROM AUTHOR]

This paper focuses on the impact of the educational mismatch on workers' fertility intentions and explores the underlying mechanisms. Empirical research based on the China Family Panel Survey (CFPS) data shows that undereducation has a negative effect on the fertility intentions of women aged 18–35, whereas overeducation reports no effect, a finding that remains stable in the robustness test and the IV model. An explanation for this phenomenon is that undereducated female workers have a wage premium and higher expectations of career development, which implies a greater opportunity cost of fertility. The heterogeneity analysis shows that women with low socio-economic status, especially those who are less educated, from low-income households, and who are employed in the private sector, are more affected. It is therefore necessary to reduce the substitution risk in the labor market for this group and to lighten the fertility burden and pressure on women. [ABSTRACT FROM AUTHOR]

China's low fertility rates are a major concern across all sectors of society. Fertility is a major issue related to economy, society and family development. Based on social norms theory, this paper explores the influence of social norms on individuals' fertility intentions from two perspectives: spatial proximity and social proximity. Using data from the China Family Panel Studies, we found that individual's fertility intentions were influenced by social norms; both neighborhood social norms and group social norms had significant effects. The role of social norms in shaping individual fertility intentions varied by gender, hukou, and life course; specifically, men, rural residents, and married individuals were more significantly influenced by social norms. This study improves the theoretical framework of fertility decision making by arguing that in addition to macro and individual factors, social norms have a very important influence on fertility intentions. Our findings suggest that reshaping social norms regarding fertility is essential to enhance fertility rates in China. [ABSTRACT FROM AUTHOR]

With the growth of the proportion of the ageing population, the problem of population ageing in China has become increasingly prominent because the implementation of family planning policy intensifies the speed of ageing development in China. The restructuring of family structure caused by social reasons, "421" and "422" have become the current family structure mode. With the vigorous development of the economy, the traditional mode and way of the traditional mode and way of providing for the aged cannot meet the spiritual and life needs of the elderly. Most of the institutions only develop the projects to provide for the aged, but not combined with the traditional way of providing for the aged in China. Based on the two-way needs of the young and the elderly, this paper combines the traditional culture with China's current national conditions and constructs the most suitable pension mode for China's traditional pension mode and Chinese people. [ABSTRACT FROM AUTHOR]

China has experienced both ultra-low fertility and moderate aging in recent years, both of which pose serious challenges to the country's development. Previous studies have shown that social capital is one of the most important factors that influences fertility intentions, but so far empirical research on the relationship between social capital and fertility intentions is very limited. Therefore, this study aims to explore the impact of social capital on fertility intentions and its underlying mechanisms by combining offline and online social capital. Based on data from the Chinese General Social Survey, the fertility intentions of 7,518 respondents aged 18–60 years were analyzed and broken down by sex, region, and age. The marginal effects and mechanisms of offline and online capital on fertility intentions were explored using an ordered probit (oprobit) model, which revealed that individuals' fertility intentions are positively influenced by offline social capital but negatively influenced by online social capital. The role of social capital in shaping individuals' fertility intentions also varies by gender, region, and age. Women, eastern region groups, and those aged 30–60 years are more influenced by offline social capital, and their intentions become stronger as offline social capital accumulates. However, online social capital negatively affects the fertility intentions of women, Midwesterners, and 18–29 year olds. Furthermore, online and offline social capital mainly influence individuals' fertility intentions by affecting their perceptions of pensions, filial piety, and "social justice". Our findings suggest that increasing the value that individuals place on social capital is crucial for improving fertility intentions in China. [ABSTRACT FROM AUTHOR]

Background: Female sex workers (FSW) are particularly vulnerable to unintended pregnancy. Research examining the experience of unintended pregnancy due to commercial sex among Chinese FSW, however, is limited. This study aimed to examine the prevalence and correlates of unintended pregnancy due to commercial sex among FSW in China. Methods: In 2021, a cross-sectional study was conducted among 1257 FSW in five cities from Guangdong provinces in South China. Data were collected on social-demographic characteristics, sexual behaviors, experience of unintended pregnancy due to commercial sex and its pregnancy outcome, as well as experience of abortion in lifetime. Multivariable logistic regression analysis was employed to identify factors associated with unintended pregnancy. Results: Among the 1257 FSW, 19.3% reported having at least one unintended pregnancy due to commercial sex. Of those, 96.7% chose to terminate the pregnancy through induced abortion, and 40.5% reported undergoing multiple induced abortions in their lifetime. Multivariable logistic regression indicated that FSW working in current location over one year (adjusted Odds Ratio (aOR): 2.82, 95% CI 1.71–4.64) and having more than seven clients in the past week (aOR: 4.53, 95% CI 2.74–7.51) were more likely to have had unintended pregnancy due to commercial sex. Working in high tier (aOR: 0.21, 95% CI 0.14–0.30) and consistent condom use with clients in the past month (aOR: 0.16, 95% CI 0.10–0.23) were associated with a lower proportion of FSW having ever had unintended pregnancy. Conclusions: Unintended pregnancy are prevalent among FSW in South China. Interventions aimed at reducing the prevalence of unintended pregnancy and enhancing post-abortion care could be necessary among Chinese FSW. Plain English summary: Female sex workers (FSW) are particularly vulnerable to unintended pregnancies. Research on the experience of unintended pregnancy resulting from commercial sex among Chinese FSW is, however, limited. To address this knowledge gap, we investigated the prevalence and correlates of unintended pregnancies due to commercial sex among FSW in China. We conducted a cross-sectional study among 1257 FSW in five cities across Guangdong Province in South China in 2021. Multivariable logistic regression analysis was used to identify factors associated with unintended pregnancy. Among 1257 FSW, 19.3% reported having experienced at least one unintended pregnancy due to commercial sex. The factors significantly associated with unintended pregnancy in the multivariate analysis included participants working in high tier, working in current location over one year, using condom with clients inconsistently in the past month, and having more clients in the past week. The findings from this study could provide valuable insights for the development of policies aimed at reducing unintended pregnancies, improving abortion care, and enhancing family planning programs targeted at FSW. [ABSTRACT FROM AUTHOR]

In recent years, an emerging discourse on various social media platforms has drawn attention to the enduring, yet unspoken, distress experienced by a considerable number of Chinese women who have utilized intrauterine devices (IUDs) for extended durations. Using corpus linguistics and thematic analysis, this article seeks to explore the use of metaphors in discussions about IUDs on Weibo and how the public makes sense of roles of spouses in the decision of using IUDs. The findings reveal three distinct metaphors about IUDs within multi-layered family and social relationships: a time bomb, a blood-stained wedding ring, and a lethal weapon. Furthermore, three metaphorical representations of the spousal roles in relation to the use of IUDs are identified: participants versus observers regarding contraception, perpetrators versus victims within societal frameworks, and the nurturing cornerstone of the family versus instrumental means for procreation. These metaphors, deeply rooted in war metaphors, not only reflect the oppressive forces imposed on women by state power, patriarchal society, and traditional beliefs but also function as a form of resistance against such forces. [ABSTRACT FROM AUTHOR]

China has low birth rates at higher parities and intensive grandparental childcare. Despite this, there has been little empirical research into the role of intergenerational support in the transition to second birth. This study examines whether grandparental childcare increases the likelihood and speed of a transition to second birth in the context of relaxations in Chinese family planning policy and whether this differs for working and non-working mothers. Using data from the China Family Panel Studies (2010–2016), the association between grandparental childcare, mother's working status and second childbirth are explored using split-population survival models to distinguish between the impact on the timing of fertility and ultimate parity progression. The odds of having a second child are four times higher for those who use grandparental childcare than those that don't. Amongst those who have a second child, grandparental childcare leads to 30% lower odds of transition to second birth than those without grandparental care, each month. Grandparental childcare is also associated with maternal employment, which is itself associated with a sharp decrease in the transition to second birth. At the micro-level, grandparental childcare helps mothers continue working, which in turn defers a second birth. The results emphasise the importance of work-life balance strategies, such as grandparental care, in enabling women of childbearing age to realize their fertility intentions in combination with work. [ABSTRACT FROM AUTHOR]

The ongoing population aging and few children are major challenges for human sustainable development in the 21st century. While the external environment is a crucial factor determining people's behaviour, the potential effects of subjective environmental quality on an individual's fertility decision‐making remain poorly understood. Using data from the Chinese General Social Survey, this research has examined the relationship between environmental quality perception and fertility intention in China. Results reveal that an increase in environmental quality perception can significantly promote people's fertility intention. Our study proposes and verifies two pathways through which environmental quality perception affects fertility intention, namely, well‐being and future expectation. This facilitating effect is greater for people with poor socio‐economic conditions. The findings indicate that policymakers should coordinate environmental protection and population policies to promote sustainable development and design various tools targeted based on people's socio‐economic background. [ABSTRACT FROM AUTHOR]

We describe a key moment during the world's attempt to come to terms with enormously expanding populations. China was an extreme case, both in the magnitude of its population explosion and in its government's control of reproduction through the One-Child Policy (OCP). The U.S. had been a founder and the main financial supporter of The United Nations Population Fund (UNFPA). Starting in 1998, UNFPA's program in China attempted to move the OCP away from two decades of coercive family planning and toward acceptance of the women's rights–centered global consensus that emerged from the 1994 Cairo Conference on Population and Development. In 2001, a conservative U.S. organization, the Population Research Institute, claimed to have gathered evidence of UNFPA's involvement in Chinese coercion. Although several investigations, including one sent by President George W. Bush himself, refuted this evidence, and UNFPA had used no U.S. funds in China, conservative political power was sufficient to cause President George W. Bush to eliminate all U.S. funding for UNFPA's activities everywhere in the world. Ironically, this period was exactly when the UNFPA project had shown that coercion was unnecessary. China eventually followed the UNFPA's lead, liberalizing and eventually ending the OCP. [ABSTRACT FROM AUTHOR]

Public health service is an important guarantee by the government to safeguard the health rights of rural migrant women. This not only concerns the health status of rural migrant women and their willingness to stay in the urban area but can also affect their fertility intention. This study systematically examined the impact of public health services on the fertility intentions of rural migrant women as well as the mechanisms, underlying these intentions based on the data from the 2018 China Migration Dynamics Monitoring Survey. Urban public health services, including health records management and health education, could effectively enhance the fertility intentions of rural migrant women. Furthermore, their health status and willingness to stay in urban areas were important mechanisms, by which, the public health services could influence the fertility intentions of rural migrant women. Additionally, urban public health services have a better effect on improving the fertility desire of rural migrant women who have no pregnancy experience, a low income level, and a short residence time in the inflow area. This study contributed to the examination and clarification of the policy effects of public health services on the fertility intentions of rural migrant women. Additionally, it also provided important evidence to support the government policies related to the optimization of the public health service system, improvement of the health status, citizenship, and fertility intentions of the rural migrant women, as well as the development of the uniform public health services. [ABSTRACT FROM AUTHOR]

In 2013, the Chinese government implemented a two-child policy to increase the country's fertility rate. However, the persistently low rates necessitated other measures to boost fertility. This study empirically investigated the association between intergenerational support and second-child fertility intention in the Chinese sandwich generation and demonstrated the mediating role of parental burnout and burnout in caring for grandparents. Survey data collected at Time 1, Time 2, and Time 3 included 2939 participants from different regions of China. Before analyzing the data, coarsened exact matching and propensity score matching was conducted to reduce sampling bias. Regression analysis results indicated that intergenerational support has a significant total positive effect on second-child fertility intention. Furthermore, mediation path analysis revealed that parental burnout and burnout in caring for grandparents play significant but opposite directional mediating roles in the association between intergenerational support and second-child fertility intention. Sensitivity analysis using different calipers yielded similar results. These results indicated that second-child fertility intention can be increased among the Chinese sandwich generation with intergenerational support, by mitigating parental burnout. However, intergenerational support did not alleviate burnout in caring for grandparents in the sandwich generation; therefore, formal older adult care policies are required to help the sandwich generation experience lower burnout, while receiving intergenerational support. [ABSTRACT FROM AUTHOR]

Background: Pharmacotherapy is one of the primary treatments for patients with Assisted reproductive technology (ART). Despite the publication of various research on ART treatment, there is no clear conclusion regarding the choice of drug treatment in China. Our research intends to examine the trend of widely prescribed medications for ART patients in China. For instance, the study examines the logic of drug indications, usage, and dose in patient prescriptions. Methods: We did a cross-sectional study of the data from the hospital prescription analysis cooperation project supervised by the China Medical Association. The information is extracted from the prescriptions of reproductive assistance outpatients from January 2016 to December 2020. We used the U.S. Food and Drug Administration (FDA) classification to quantify the frequency of drug use and the categories of drugs. We manually extract the information of patients who require ART treatment, divide the patients into various age groups and geographies, followed by study the indications, utilization, and rationale of the most important therapeutic medications. Results: Among the 225225 patients included in this study, Guangzhou (47.83%), Shanghai (19.84%), and Zhengzhou (9.36%) were the top three cities. In the past 5 years, the average age was 32.99, and 60.38% of women were between the age of 25 and 34. The main therapeutic medicines taken by each patient, primarily hormone therapies, were tallied. Eleven types of primary therapeutic medicines were employed. Different progesterone preparations (47472, 21.08%), chorionic gonadotrophin gondotrophin for injection (38932, 17.29%), dydrogesterone tables (33591, 14.91%), and triptorelin for injection (26959, 11.97%) rounded out the top five. According to the data on outpatient medications in major cities in China, the variety and proportion of injections are the highest, including the most frequent types of ovulation induction and urotropia, as well as triptorelin and progesterone. Even though the total dosage of urotropin was the highest in 5 years, it showed a declining trend. The dosages of progesterone and didroxyprogesterone increased, with progesterone showing the most rapid increase. The top five most expensive prescription medications are triptorelin, urotropin, progesterone, didroxyprogesterone, and leuprorelin, in that order. Goserelin, leuprorelin, triptorelin, growth hormone, and didroxyprogesterone are among the top five most expensive medications per capita. Conclusion: The average age of patients has not increased considerably over the past 5 years. However, the opportunity cost of childbirth for women has increased, which has significantly enhanced their willingness for childbearing intentions. The medication selection is reasonable overall. In this study, the recommended dosages of first-line medicines (urotropin and chorionic gonadotropin) are likewise high. In contrast, the dosage of oral first-line treatment for ovarian stimulation in unexplained infertility is modest, and the dosage of progesterone is steadily increasing. In addition, the price of certain medicines is high, which will increase the patients' financial burden. Future research will focus on enhancing the degree of rational drug use among outpatients and realizing the economical, safe, and effective use of pharmaceuticals to lessen the economic burden of patients. [ABSTRACT FROM AUTHOR]

The research uses CGSS, a family survey data, to study the impact of the second phase of the selective two-child policy (STCP II) on residents' fertility intentions in China. It finds that the policy does improve residents' two-child fertility intentions, which is more significant in the younger groups. The research results suggest that relaxing the family planning policies does increase the residents' willingness to have more children in the short term. [ABSTRACT FROM AUTHOR]

How trade liberalization affects a country's fertility has been verified by some studies, but little is known about how export trade liberalization impacts individual fertility intention. Using China Health and Nutrition Survey data from 1997 to 2011 and regression analysis, this study finds that a decline in the average external tariff significantly improves the fertility intentions of married women. This conclusion remains robust after overcoming endogeneity problems using an alternative external proxy variable, adopting different average tariff calculation methods, adding other control variables, and considering the son preference. The mechanism test shows that export trade liberalization can affect married women's fertility intentions by affecting family income; moreover, the income effect dominates the substitution and intra‐marital income gap effects. This study provides a new perspective for understanding changes in fertility intention in developing countries. This perspective can promote academic research progress in this field and be of great significance in formulating effective policies to improve fertility intention. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is crucial for the preterm infants. Breast milk is not only food but also medicine. Few studies have focused on the longitudinal effects of exclusive breastfeeding outcome of preterm infants separated from their mothers after discharge, especially in Shanghai. We aimed to examine the exclusive breastfeeding rate and duration amongst first time mothers of preterm infants after discharge and its determinants. Methods: Analyses were based on 500 preterm infants separated from their mothers in a tertiary maternity and infant-specialized hospital in Shanghai from September 2018 to September 2019.The Socio-demographic characteristics, breastfeeding knowledge questionnaire, breastfeeding self-efficacy short form scale, Edinburgh postpartum depression scale and breastfeeding family support scale were used for the investigation and the exclusive breastfeeding rate of premature infants was followed up on 1 month, 3 months and 6 months after discharge. The changing trend of breastfeeding knowledge, breastfeeding self-efficacy, postpartum depression and family support were measured by ANOVA at different stages. Using the chi-square test and multiple logistic regression, factors impacting the breastfeeding rate of preterm infants at three time intervals after discharge were investigated. The Kaplan Meier survival curve and cox regression model were used to analyze the determinants of exclusive breastfeeding duration of premature infants after discharge. Results: Exclusive breastfeeding rates were 19.0, 17.2 and 10.4% at 1 month, 3 months and 6 months after discharge of preterm infants, respectively. The average length of exclusive breastfeeding duration was(3.69 ± 1.80)months. Finally, type of delivery (adjusted odds ratio [AOR] 1.564; 95% confidence interval [CI] 0.513,3.116), gestational age(AOR 0.612, 95% CI 0.236, 3.418), maternal family support (AOR 6.125,95% CI 6.359, 98.452) were discovered to be independent predictors on the exclusive breastfeeding rate at 6 months after preterm infants were discharged. Through the cox regression model, we found that a maternal planned pregnancy (HR 0.681, 95%CI 0.531,0.873), delivering breast milk during hospitalization (HR 0.797, 95%CI 0.412,2.288), NICU feeding mode during hospitalization (HR 1.221, 95%CI 0.128,1.381) and family support (HR 0.561, 95%CI 0.004,2.428) were significantly associated with the exclusive breastfeeding duration after discharge. Conclusions: The exclusive breastfeeding outcome of premature infants was affected by many factors, so we should focus on the three levels of individual, family, society and design targeted intervention measures to increase the exclusive breastfeeding rate and prolong exclusive breastfeeding duration. [ABSTRACT FROM AUTHOR]

Background: The period fertility in China has declined to very low levels, and the completed cohort fertility rate (CFR) has also decreased significantly. However, the exact fertility rate remains controversial. While the tempo effect has played a significant role in China's period fertility decline, child underreporting has to be taken into consideration in China's fertility research. Methods: By using the census data from 1982 to 2010, and the 1% population sample survey data from 1995 to 2015, we systematically analyzed China's fertility and its trends since the 1980s using period fertility measures, adjusted period fertility measures, cohort fertility measures, and indirect estimation methods. Results: The results show that marriage postponement significantly affects the TFR decline. Even after eliminating the tempo and parity structure effect, the adjusted TFR has fallen below 1.5, and the first-order fertility rate dropped to 0.9 in 2015. The CFR for women aged 45–49 declined from 5.37 in 1982 to 1.62 in 2015 mainly because of a decrease in fourth and higher-order births from 1982 to 1990, a decrease in second and third births from 1990 to 2000, and a decrease in second births from 2000 to 2015. Indirect estimation methods yielded a TFR in the range of 1.5–1.6 for the period 2000–2010 and an average TFR of 1.49 for the period 2011–2020. Conclusions: The traditional norm of universal marriage and childbearing for Chinese women is changing. China's fertility has been steadily declining, as measured by both period and cohort indicators. Following the historical change, fertility may continue to decline even after introducing the universal three-child policy in China in 2021. [ABSTRACT FROM AUTHOR]

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