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Background: Inter-delivery interval (IDI) has been proven to be a factor associated with adverse maternal and neonatal outcomes. However, the optimal IDI in trial of labor after cesarean delivery (TOLAC) remains unclear. We aimed to investigate the association between IDI and major maternal and neonatal outcomes in women who underwent TOLAC. Methods: A multicenter, retrospective cohort study including five hospitals was conducted between January 2018 and December 2019 in Foshan, China. This study included 1080 pregnant women with one or two cesarean deliveries who attempted a TOLAC. Data on maternal and neonatal outcomes were collected from the electronic record system. Maternal and neonatal outcomes in different groups of IDI were compared by univariate and multivariable analyses. Results: A short IDI of < 24 months did not show a statistically significant association with uterine rupture in the univariate analysis (P = 0.668). In multivariable analysis, the incidences of postpartum hemorrhage (OR 19.6, 95% CI:4.4–90.9, P < 0.05), preterm birth (OR 5.5, 95% CI:1.5–21.3, P < 0.05), and low birth weight (OR 3.5, 95% CI:1.2–10.3, P < 0.05) were significantly increased in women with an IDI of < 24 months than in those with a normal interval (24–59 months). Infection morbidity (OR 1.8, 95% CI:1.4–7.9, P < 0.05), transfusion (OR 7.4, 95% CI:1.4–40.0, P < 0.05), and neonatal unit admission (OR 2.6, 95% CI:1.4–5.0, P < 0.05) were significantly increased in women with an IDI of 120 months or more than in those with a normal interval. Postpartum hemorrhage (P = 0.062) had a trend similar to that of a significant IDI of 120 months or more. We found no statistically significant difference in maternal and neonatal outcomes between 24–59 months and 60–119 months. Conclusions: An IDI of less than 24 months or 120 months or more increased the risk of major maternal and neonatal outcomes. We recommend that the optimal interval for women who underwent TOLAC should be 24 to 119 months. Plain Language summary: An inter-delivery interval (IDI) that is too short or too long increases the risk of adverse maternal and neonatal outcomes. However, the optimal IDI for trial of labor after cesarean delivery (TOLAC) remains unclear. We performed a multicenter, electronic medical record-based, retrospective cohort study that included 1080 pregnant women who had one or two cesarean deliveries and underwent TOLAC. Data on maternal and neonatal outcomes were collected from the electronic record system. In multivariable analysis, the incidences of postpartum hemorrhage, preterm birth, and low birth weight were significantly increased in women with an IDI of < 24 months than in those with a normal interval (24–59 months). Infections, transfusion, and neonatal unit admission were significantly increased in women with an IDI of ≥ 120 months than in those with a normal interval. In conclusion, we found that an IDI < 24 months or ≥ 120 months increased the risk of major maternal and neonatal outcomes. We recommend that the optimal interval for women who underwent TOLAC should be 24 to 119 months. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether recurrent gestational diabetes mellitus (GDM) and newly diagnosed GDM share similar risk factors. Methods: The study recruited a cohort of 10,151 multipara women with singleton pregnancy who delivered between 2016 and 2019 in Beijing, China. The prevalence of recurrent GDM and associated risk factors were analyzed between women with and without prior GDM history. Results: Eight hundred and seventy-five (8.6%) multipara women had a diagnosis of GDM during previous pregnancies. The prevalence of GDM and pre-gestational diabetes mellitus were 48.34% (423/875) and 7.89% (69/875) if the women were diagnosed with GDM during previous pregnancies, as compared to 16.00% (1484/9276) and 0.50% (46/9276) if the women were never diagnosed with GDM before. In women without a history of GDM, a variety of factors including older maternal age, higher pre-pregnancy body mass index (PPBMI), prolonged interval between the two pregnancies, higher early pregnancy weight gain, family history of type 2 diabetes mellitus (T2DM), maternal low birth weight, and higher early pregnancy glycemic and lipid indexes were generally associated with an increased risk of GDM at subsequent pregnancy. In women with a history of GDM, higher PPBMI, higher fasting glucose level and maternal birthweight ≥4000 g were independent risk factors for recurrent GDM. Conclusions: GDM reoccurred in nearly half of women with a history of GDM. Risk factors for recurrent GDM and newly diagnosed GDM were different. Identifying additional factors for GDM recurrence can help guide clinical management for future pregnancies to prevent GDM recurrence. [ABSTRACT FROM AUTHOR]

Recent studies on the determinants of entrepreneurship have shown that later-born children are more likely to become entrepreneurs. However, research has not addressed the questions of how birth order influences entrepreneurship. Based on the Chinese context, we propose two competing hypotheses to explore the potential mechanisms (risk taking vs. educational attainment) that explain the effect of birth order on entrepreneurship. We further argue that the effect of birth order on entrepreneurship is moderated by birth spacing and family financial status. Using data from the 2008 and 2013 Chinese Household Income Project, we find that in the case of China the impacts of birth order on two types of entrepreneurship (i.e. solo entrepreneurship and employer entrepreneurship) are overall positive, which implies that the risk-taking mechanism is more dominant than the educational attainment mechanism. Birth order shows a more pronounced impact for solo entrepreneurship but a weak impact for employer entrepreneurship. We also find that the positive birth-order effect on entrepreneurship is more evident in families with low financial status. Overall, this paper casts light on how birth order shapes the propensity for entrepreneurship. [ABSTRACT FROM AUTHOR]

Air pollution is a serious environmental problem in China. Birth defects are particularly vulnerable to outdoor air pollution. Our study was to evaluate the association between short-term exposure to air pollutants and the risk of birth defects. Daily data including the air pollutants, meteorological characteristics, and birth records were obtained in Hefei, China, during January 2013 to December 2016. The findings showed that PM2.5, PM10, SO2, NO2, and O3 exposures were positively correlated with the risk of birth defects. Maternal exposure to PM2.5 and SO2 during the 4th to 13th gestational weeks was observed to have a significant association with the risk of birth defects, with the maximum effect in the 7th or 8th week for PM2.5 and the maximum effect in the 7th week for SO2. The positively significant exposure windows were the 4th to 14th weeks for PM10, the 4th to 12th weeks for NO2, and the 26th to 35th weeks for O3, respectively. The strongest associations were observed in the 8th week for PM10, the 7th week for NO2, and in the 31st or 32nd week for O3. The findings of this study demonstrate that air pollutants increase the risk of birth defects among women during pregnancy in Hefei, China, which provide evidence for improving the health of pregnant women and neonates in developing countries, and uncovered potential opportunities to reduce or prevent birth defects by proactive measures during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the effects of a short interpregnancy interval (IPI) (< 6 months) and a long IPI (> 120 months) on neonatal adverse birth outcomes including low birth weight (LBW), small for gestational age (SGA), preterm birth (PTB), and birth defects in Shaanxi Province. Patients and Methods: A stratified multistage random sampling method was used to recruit participants who gave birth between 2010 and 2013 in Shaanxi province. A self-designed questionnaire was used to collect the information of the participants. With the confounding factors controlled, the generalized linear model (GLM) was used to investigate the association between IPI and neonatal birth outcomes. The restricted cubic spline (RCS) function was used to evaluate the dose–response relationship between IPI and birth outcomes. Results: A total of 13,231 women were included. The prevalence of LBW, SGA, PTB, and birth defects was 3.24%, 12.96%, 2.93%, and 2.12%, respectively. GLM showed that a short IPI (< 6 months) was associated with a higher risk of SGA (RR=1.25, 95% CI: 1.04– 1.52) and birth defects (RR=2.55, 95% CI: 1.45– 4.47), and a long IPI (≥ 120 months) was associated with a higher risk of LBW (RR=1.54, 95% CI: 1.01– 2.34) and PTB (RR=1.73, 95% CI: 1.08– 2.76) than an IPI of 18– 23 months. The RCS showed that LBW, SGA, and PTB demonstrated a j-shaped relationship with IPI (P for overall association < 0.001 for these three birth outcomes), and birth defects (P for overall association < 0.001) had an inversely non-linear relationship with IPI. Conclusion: Both short and long IPIs are associated with an increased risk of adverse birth outcomes. [ABSTRACT FROM AUTHOR]

This study focused on the effects of the neighbourhood on the fertility outcomes among marriage immigrant wives in Taiwan. In particular, we investigated the effects of the proportion of marriage immigrants in the neighbourhood and ethnic composition of the neighbours on fertility behaviours of foreign wives. The study further explored whether and to what extent commercialised cross-border marriages moderate the relationships. Micro-data from the 2013 Living Demand of Foreign and Mainland Spouses and administrative data for 21 cities and counties were utilised in this study. We found that immigrant wives in an area with a higher proportion of marriage immigrants were likely to have higher fertility and shorter intervals between births. Immigrant wives who married through a broker were likely to have lower fertility if they were living in a neighbourhood with a higher proportion of marriage immigrants. The proportion of immigrants from Mainland China in the neighbourhood was negatively associated with fertility among immigrant wives from Mainland China. [ABSTRACT FROM AUTHOR]

Background: Poor 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.Methods: A 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.Results: A 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).Conclusions: Women 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. [ABSTRACT FROM AUTHOR]

Timing and synchrony of birth influence the survival of offspring and the recruitment rate of population as well as the survival and future reproductive success of females. However, there are few studies on the timing of birth and its ecological significance of captive Alpine musk deer (Moschus sifanicus). Birth date of 332 captive Alpine musk deer were recorded between 2011 and 2017 in Xinglongshan Breeding Center of Alpine Musk Deer, Gansu Province, northwestern China. Parturition timing, parturition synchrony and birth season of Alpine musk deer were analyzed, and the effects of initiation date, climate condition, age and reproductive experience on parturition date were examined. Results showed that parturition period of captive Alpine musk deer ranged from April to September, and 80.4% of birth was concentrated in June. Median date was June 21st (i.e. average timing date) and the average parturition season was 40 days, i.e., the time for 75% of parturition to be accomplished. Median date of 2013 was significantly later than the other years (p < 0.05). Parturition season was significantly different between years (p < 0.05), but the degree of synchrony did not vary among years (p > 0.05). In addition, Initiation date exerted significant influence on parturition season (p < 0.05). In relation to climate condition, the peak period of birth took place earlier than the precipitation and temperature crests. Temperature of October and December had a significant impact on the birth time in the following year (all p < 0.05). In conclusion, Alpine musk deer has a stable pattern of parturition adapted to a captive environment. Temperature is still an important environmental factor affecting the parturition of captive Alpine musk deer. [ABSTRACT FROM AUTHOR]

The retrospective cohort epidemiological study was to investigate the characteristics of women who underwent induced abortion. Data were retrospectively collected from women who underwent induced abortions (n=19,655) at the Xiamen Maternity and Child Health Care Hospital (2010–2013). The characteristics of women who underwent induced abortions included mean age, unmarried status, no previous deliveries, first pregnancy, ≥2 abortions including the current one, and a history of caesarian section. From 2010 to 2013, mean age increased and declines were observed in the ratio of induced abortions to live births, the proportion of induced abortions among women of 15–24 years, those who were unmarried, had their first pregnancy, or had no history of delivery. However, the rates of induced abortions increased among women who were lactating, had a history of caesarian section, or had an interpregnancy interval of <6 months. This snapshot of induced abortions in China might suggest that the numbers are increasing but the ratio to live births has fallen. Methods should be improved to prevent unwanted pregnancies and reduce the number of induced abortions in China. It must be emphasized that differences in mentality and culture between countries might limit the representativeness of these results. [ABSTRACT FROM AUTHOR]

Background: The association between maternal interpregnancy interval (IPI) and congenital heart disease (CHD) in neonates remains inconclusive. This study aimed to examine the effect of maternal IPI on birth risk of CHD., Methods: Chinese women with two consecutive singleton deliveries in Guangzhou between January 2014 and December 2019 were selected as participants. Information on IPI and CHD was extracted from the Guangzhou Perinatal Health Care and Delivery Registry and the Guangzhou Birth Defects Surveillance Program. We stratified IPI into four categories: <24 months, 24-35 months, 36-59 months, and ≥60 months. A multivariate logistic regression model was used to examine the association between IPI and CHD. Subgroup analysis was also performed to assess whether the associations differed across top three CHD subtypes., Results: For 119,510 women enrolled in this study, the mean ages at two consecutive deliveries were 26.2 ± 3.8 and 28.8 ± 4.0 years, which yielded a median IPI of 51.2 (interquartile range, 32.1-77.2) months. Among them, 828 delivered infants with CHD during their second pregnancy. There was a J-shaped curve relationship between IPI and CHD with the lowest birth prevalence (5.33‰) at 24-35-month interval. Compared to women with an IPI of 24-35 months, those with an IPI ≥60 had an increased risk of delivering infants with CHD (adjusted odds ratio (OR), 1.41; 95% confidence interval (CI), 1.19-1.64). However, for those with an IPI <24 months (adjusted OR, 1.24; 95% CI, 0.97-1.51), IPI was statistically insignificant associated with the risk of delivering infants with CHD ( p  = .12). There were different patterns of associations for different CHD subtypes., Conclusions: Longer maternal IPI (≥60 months) was associated with an increased risk of delivering infants with CHD in the Chinese population.

This paper investigates the relationship between family structure and high school enrollment among adolescents ages 17-18 in the context of large-scale labor migration. Analysis of China's 2000 Census data reveals a significant educational gap across (1) family types and (2) living arrangements within each family type. Children of two-parent families are better off than those of divorced families, widowed families, stepfamilies, and no-parent families; children of two-parent families but living with only the mother are better at school enrollment than those from single-father and widowed-mother families. These findings reflect the strong correlation between family structure and adolescents' degree of education beyond the compulsory level in contemporary China. The results are somewhat inconsistent with those of relevant studies in developed and developing settings. Because high school education plays an important role for individual socioeconomic mobility, the disadvantages faced by children of single-father and widowed-mother families are likely to have detrimental and long-term consequences for the children, the family, and society. [ABSTRACT FROM AUTHOR]

Abstract: Background: In China, contraception is the most commonly used practice adopted by couples seeking to limit their number of children and to determine the time interval between births. Since 1980, the implementation of mandatory contraceptive strategy has reduced the fertility rate. Using large-scale data from national statistics and nationally representative sample surveys, the current study aims to assess Chinese trends in contraceptive use and determinants of choice from 1980 to 2010 among married women and men aged 20–49 years. Study Design: Since 1980, national data on contraceptive methods utilization have been gathered by the National Population and Family Planning Commission of the People''s Republic of China (NPFPC). Additionally, data from three roughly representative decennial samples (1988, 1997, 2006) of Chinese women of aged 20 to 57 years have been gathered by the NPFPC through the National Family Planning and Reproductive Health Surveys in China. Results: A relatively stable Chinese mode of contraception has been established and maintained since the 1980s. This is characterized by long-term contraceptive use which is still dominant in current China. In addition, China''s total contraceptive prevalence rates remain at the highest level across the globe from 1980 to 2010. However, the overall method composition of contraceptive use within China has changed since the mid-1990s. Over the study period, the prevalence rate of sterilization increased from 30.21% in 1980 to 46.47% of married women of reproductive age (20–49 years) in 1994 and then declined to 31.7% in 2010. At the same time, intrauterine device usage increased (39.83% in 1980 to 48.15% in 2010), as did oral contraception (0.3% in 1980 to 0.98% in 2010) and condom usage (2.35% in 1980 to 9.32% in 2010). The results from the multinomial logit model show that an individual''s contraceptive choice depends not only on individual characteristics, including ethnicity, age, education level, household registration, region, number of living children and sex of the last living child, but also on the strength of family planning policies. A positive coefficient indicates that the looser the strength of family planning policies is, the more likely the individual is to choose condoms or another short-term contraceptive method. Conclusions: Long-term contraceptive use is still dominant in China. In fact, over the 30-year period (1980–2010) and in comparative world perspective, China continues to have the highest total contraceptive prevalence rate. Additionally, an individual''s contraceptive choice is jointly influenced by the strength of family planning policies and individual characteristics. [Copyright &y& Elsevier]

Abstract: Background: China launched a nationwide family planning program offering birth control methods and family planning services in the 1970s. Promotion of the widespread use of long-term contraceptive methods has been one of the program''s core strategies. This paper reviews the history of China''s Family Planning Program at the national level from 1970 to 2010. Special attention is paid to the history of contraception policy. Study Design: This study provides an overview of the last four decades of the Chinese Family Planning Program. Programmatic goals are highlighted during different time periods, with special attention being paid to the role of contraceptive use and the history of contraceptive policy. Results: The Chinese Family Planning Program has experienced several transitions. It has evolved from the 1970s period of moderate policy, represented by wan, xi, shao (late marriage and childbearing, birth spacing and limited fertility), through the strict one-child policy of 1979 to the early 1990s. From the mid-1990s to the present, a relatively lenient policy has been in force, characterized by client-centered informed choice. Conclusions: The success of the Chinese Family Planning Program has long been heavily dependent on policies advocated by the central government, including programs promoting contraception to reduce fertility rates. The Program also depended on a logistical support system, including organizational safeguards and free provision of contraception and family planning services. [Copyright &y& Elsevier]

China's family planning programs have emphasized delayed marriage and longer spacing between births. Since 1970, the fertility has declined from 6 to 1.8 births and the mean age at first marriage has gone up but the recommended spacing intervals have not been fully realized. Despite the fertility decline it is being debated among scholars whether China has completed a sustainable demographic transition or not, especially in rural areas. The aim of this study was to analyze trends in the timing and patterns of marriage and childbearing in relation to successive family planning policies. A cluster random sample of 1,336 women aged 15-64 at the time of the survey (2000) was selected in one rural county in Yunnan province. Life-table techniques were used to analyze the cumulative proportion of women marrying and having a certain number of births. Cox's hazard regression model was used to estimate the effects of various covariates on the "hazard" for a woman to have a second birth. Our findings demonstrate how childbearing patterns have changed in the direction of delayed marriage, a decreased interval between first marriage and first child, and significantly longer spacing between the first and second child. This transformation of childbearing patterns corresponds well with the requirements of the policies. Considering the characteristics of Yunnan, it seems likely that the changing fertility behavior has been more influenced by a strictly enforced family planning policy than by societal changes leading to the adoption of a new, smaller family norm. [ABSTRACT FROM AUTHOR]

Using a sample of couples drawn from the three provinces of Guangdong, Shandong, and Shaanxi, we investigated whether couples' increasing freedom to choose whom to marry influenced the timing of first birth in rural China during the four decades before the 1990s. The shortening of first-birth intervals in the period is found to be associated with the shift from arranged to free-choice marriages. The association is attributed largely to increased intimacy and coital frequency after marriage together with postponement of age at first marriage. [ABSTRACT FROM AUTHOR]

We examine the effect of socio-economic covariates on infant mortality in China in the 1980s, particularly the role of previous birth interval and mother's education, using an event history approach with data from the 1988 Two per Thousand Fertility Survey. We use a Bayesian model averaging strategy that takes account of model uncertainty as well as parameter uncertainty. A standard stepwise logistic regression analysis finds no statistically significant relationship between the preceding birth interval and infant survival after controlling for socio-demographic factors, but this finding is reversed when the Bayesian model averaging approach is adopted. However, the method finds less support than a standard stepwise approach for the role of mother's education. We consider the model-fitting criterion of predictive power when applied to out-of-sample observations, and show that Bayesian model averaging outperforms the stepwise approach. We conclude that, even with large sample sizes, the interpretation of results can vary substantially according to model selection and fitting criteria. [ABSTRACT FROM AUTHOR]

This article presents information on the birth planning policy of Liaoning Birth-Planning Commission of China. In order to control population numbers, to raise population quality, and to effect population growth in harmony with economic and social development, to promote socialist modernization and construction, and to ensure the prosperity of the Chinese nation, regulations are decreed in Liaoning province. Late marriage, late birth, fewer births, and better births are advocated and encouraged. Birth planning is the joint duty of both spouses. Voluntary contraception is a right of couples with reproductive ability, which is protected by law. The promotion of birth control shall mainly rely on ideological education, with administrative and economic measures playing a supplementary role. Only men above twenty-two and women above twenty years of age who have established legal marriage relations are allowed to have pregnancies and children. A couple can have only one child. But after personal application, examination, and approval by the birth-planning commission of the county and after the passing of a prescribed birth interval, they can have another child.

Under the current family planning policy in China, the criterion for evaluating all parties involved in the birth planning system provides an incentive for everyone to see that the policy is met, either in reality through strict enforcement of family planning regulations, or statistically through manipulation of statistical records. We investigate underreporting of births in four rural counties of northern China, using data from a 1992 sample survey featuring a reproductive history. To clarify the mechanisms of underreporting, we focus on the ways in which reporting errors may affect the distribution of first births by time since marriage. The results of our investigation suggest that in three of the four counties, first-birth intervals are lengthened by underreporting of girl babies and by replacing them with second births reported as first births. [ABSTRACT FROM AUTHOR]

The campaign for one-child families in the People's Republic of China has created world-wide interest. This study compares the general rates of single-child families in China and in 60 other countries and shows that China's current rate (12.5) is relatively low in comparison with some developed countries, e.g. Hungary (25.0). The mean age-specific single-child rate for 54 less developed countries shows a different pattern from that for seven developed countries; this is likely to be due to the later age of marriage and longer birth intervals of women in the developed countries. [ABSTRACT FROM PUBLISHER]

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The article reports on the Chinese approach on family planning and sex education. Mao Tse-tung recognized the population problem decades ago as evident in the speech he made to the Supreme State on February 21, 1957 where he emphasized on keeping the population on a stable level for a long period of time. With an annual growth of less than 1.7 percent. China's population approximates to 850 million today. Family planning is tied to political ideology and government policy and is now a state concern. Programs involving absence of sexual interest in teenagers, postponement of marriage until the age of mid-twenties, and avoidance of extra-marital affairs are imposed.

The article focuses on the one child family program in China. A massive educational campaign which involve drastic series of incentives and disincentives was introduced into the country to encourage parents to restrict the numbers of their children. As incentives, the one child family can avail of free medical benefits and education for their single child while the two child family will be prioritize in allocation for preferred housing. Meanwhile, a six percent deduction on the total income of the husband and wife which will be used for welfare expenses is one of the sanctions that will be levied against those couples who produce a second child after being rewarded for only having one and those who produce a third or additional child.

In this article the author presents his views on the situation of family planning work in China. Carrying out reform and opening up, developing a commodity economy, continuously stimulating the people's opening up, spiritual renewal, enthusiastic assimilation of scientific and cultural knowledge, and the pursuit of the desires of civilized, healthy, scientific family life, has assaulted ignorant, backward ideas, including old ideas about marriage and birth. Especially in cities and rural areas where the economic and cultural development is relatively fast, where the family planning policy has been well implemented, and where the construction of the socialist spiritual civilization has been carried out well, following changes in the people's production and life-styles and with the appearance and gradual increase in the number of small higher-quality families, the change in marriage and childbearing ideas has occurred even faster. At present, the main problems that exist in family planning work are: the work in some places is not firmly grasped, for a variety of reasons, and family planning is still in an unconsolidated state.

This article presents the views of the author while receiving the Report of the National Conference of Directors of Family Planning Commissions in China. Family planning work throughout the country as a whole has achieved considerable success. In particular, since the Third Plenum of the Eleventh Central Committe under the leadership of the party Central Committee, and owing to the joint efforts of the people of the entire country, the achievements have been even more remarkable than before. This is chiefly expressed by the fact that in the last few years, the natural growth rate of the population of our country has generally been controlled between 11 percent and 14 percent. This growth rate is lower than that in the 1950s and the 1960s, and lower than the average of the world's developing countries; indeed, it is lower than the world average at large. This is a result attained because we have carried out a rigorous policy of population control and family planning. Had we not done so, China's population today would not be 1.07 billion but would be a much larger number.

This article presents directive of the Central Committee of the Communist Party of China and the State Council of the Peoples Republic of China on doing a better job with family planning work, published on February 9, 1982. Since 1970s, China has attained significant success in the work of family planning. The population's natural growth rate has already been reduced from the 1970 rate of 26 per 1,000 to the 1980 figure of less than 12 per 1,000. The outstanding problem at the present moment, however, is that the rate of natural growth of the population in China is facing a trend toward resurgence. The question of how to make population growth correspond to and be compatible with the growth of the national economy is a major problem that must be resolved. In the countryside, in general, China is promoting the policy that each couple can give birth to only one child. With regard to certain people among the masses that indeed have practical difficulties and therefore request permission to bear two children, such arrangements may be permitted in a planned way and after an inspection of the circumstances and after special permission has been issued. Under no circumstances, however, should permission be given for people to bear three children. Family planning must be promoted among minority nationalities as well.

This article presents the report on the conditions of the work of family planning of the Party Group of the State Family Planning Commission, as approved and issued by the Central Committee of the Communist Party of China. The Central Committee believes that family planning is a fundamental policy of China, and a major issue that impinges on the prosperity and growth of the Chinese nation. In the past few years the work of family planning has made tremendous achievements, and from now on people must continue to exert great effort to take hold of this firmly and well. China should establish the policy of family planning on the foundation of being reasonable, taking conditions into consideration, having the support of the masses, and allowing the cadres to do a good job. This is the tough part of family planning work. Chinese people must put a great deal of effort into promoting the study of eugenics and propagating life science, and especially in the minority nationality regions and the remote mountainous regions, they must strive to promote the Marriage Law, propagandize about the harmfulness of marriages among close relatives, and prevent such marriages. Family planning operating funds must be used properly; people must use them to do solid and good work, and not spend them merely on something superficial.

Background: Even though many studies have proven the risk factors for cancer in children, studies focusing exclusively on second children are absent. This study is designed to examine the association between maternal exposure during pregnancy and the risk of developing solid tumors (STs) in second children.Methods: This retrospective matched case-control study included 80 s children with STs and 160 s children without STs matched in terms of birth weight, gestational age, pregnancy body mass index (BMI), and residence from a medical center. Exposure during pregnancy and birth characteristics of these children were investigated through structured questionnaires.Results: A univariate analysis suggested that birth spacing (OR, 12.70; CI, 4.44-36.34), maternal smoking (OR, 6.00; CI, 1.62-22.16), paternal smoking (OR, 2.20; CI, 1.23-3.93), and common cold (OR,1.94; CI, 1.02-3.69) were associated with an increased risk of second children STs. A multivariate analysis demonstrated that birth spacing (OR, 12.45; CI, 4.00-38.78) and paternal smoking (OR, 2.04; CI, 1.04-3.99) were the main risk factors for STs in second-born children.Conclusion: Long birth spacing (>10 years) and paternal smoking could significantly increase the risk of developing STs in second-born children. Despite the fact that the effects of maternal smoking and the common cold were not significant, it is still recommended to quit smoking, take necessary self-protective measures to reduce the risk of infection. [ABSTRACT FROM AUTHOR]

Purpose: In the wake of the COVID-19 outbreak, already limited services and resources for families of children with autism spectrum disorder (ASD) in China became even more scarce. This qualitative case study highlights one online parent education and training (PET) program developed during the pandemic to offer home-intervention strategies to parents of children with ASD in mainland China. This exploratory study sought to examine the emic perspectives of the trainers and parents who participated in the 12-week intensive training program while considering the cultural context in China and the transnational, remote nature of the program.Methods: The primary data focused on the experiences of the trainers and parents within PET program's structure and strategies, which were adapted from the Training of Trainers model, and were collected from semi-structured, in-depth individual and focus group interviews conducted virtually with trainers (n = 4). Supplemental data sources included training session materials and feedback forms collected from parents (n = 294) at the midpoint and end of the program. After the collected data were sorted and condensed, a thematic analysis was performed using the data analysis spiral to further organize and code the data, and the codes were finally collapsed into themes.Findings: Three overarching themes were identified: (1) training as modeling with resources, (2) dilemmas in cultural contexts and expectations, and (3) cultivating parent support networks.Conclusion: The online PET program became a hub of support networks and learning spaces for parents of children with ASD in different regions in China during the pandemic. Through the interactive virtual training sessions, parents were supported by continuous feedback on their home intervention and coached to cultivate support networks among themselves despite tensions arising from cultural differences and to implement effective intervention strategies that were individualized and authenticated to their specific familial needs. [ABSTRACT FROM AUTHOR]

Pain assessment is crucial for in-labour pain management. Even though women's self-rated pain intensity is the standard for pain relief or analgesic administration, multiparas appear to receive worse in-labour pain management than primiparas do. The discrepancy in pain perception between primiparas and multiparas remains unclear. Healthcare providers tend to think that multiparas endure the pain and report less pain because they have experienced childbirth. To retrospectively analyse the intensity of in-labour pain during first and second vaginal childbirth within the same group of women and explore whether parity may be an influential factor in labour pain intensity. Retrospective cohort study. Labour and delivery in a large academic specialized hospital in Guangzhou, China. Women were included if they had two consecutive vaginal childbirths with singleton cephalic presentations and cervical dilation ≤ 3 cm for the first childbirth and ≤ 2 cm for the second childbirth. The final study sample consisted of 417 women. All childbirth case records between January 2015 and August 2018 were scanned using a structured electronic medical system. Maternal and neonatal demographics as well as obstetric and neonatal outcomes were extracted. The in-labour pain for each childbirth was compared between first and second births. Paired t -tests, McNemar's c hi -square tests and mixed-effects modelling were applied to compare the differences in labour pain intensity between the two vaginal childbirths and explore the factors that influenced maximum labour pain scores during the second childbirth. Four hundred seventeen women were included, with an average birth interval of 1.7 years. The average maximum labour pain score during the latent phase was 6 (5,6) for the first childbirth and 5 (4,6) for the second childbirth (paired t =-6.13, P <0.001). Pain scores decreased in 28.1% (117/417) of women and increased in 13.7% (57/417) of women from the first to the second childbirth. More than half of the women in our study experienced the same maximum labour pain score during the first and second labour. Mixed-effects modelling revealed that parity, education and pregnancy complications were independently associated with maximum labour pain scores. From a clinical point of view, in-labour pain is not clinically different for women when comparing their first and second labours. Health care professionals may underestimate in-labour pain in primiparas when comparing them with nulliparas. More studies are warranted to explore options for achieving better pain management for women with more childbirths. [ABSTRACT FROM AUTHOR]

• Nearly 50% of Chinese sample had hypomanic symptoms. • Risk factors: Rural resident, education, marriage satisfaction, sleep quality, anxiety. • Higher Extraversion and lower Lie score in personality associated with hypomania. This study examines the prevalence and risk factors for postpartum hypomania in women after childbirth as well as examining the potential influence of personality traits in relation to experiencing symptoms of postpartum hypomania. A total of 1022 women no later than 1 month post-birth were recruited in Suzhou, China, between March 2017 and December 2018. Hypomanic symptoms were assessed with the Hypomania Checklist-32 (HCL-32), and a total score of 14 or higher was defined as having hypomanic symptoms. We found 43.6% of the women in our sample had hypomanic symptoms. The results of multiple logistic regression showed that rural residence [ p = 0.01, odds ratio (OR) = 0.7, 95% confidence interval (CI) = 0.5–0.9], education background (p = 0.005, OR = 0.6, 95% CI = 0.5–0.9), marriage satisfaction (p = 0.048, OR = 0.9, 95% CI =0.8–1.0), Pittsburgh Sleep Quality Index (PSQI) (p = 0.001, OR = 0.9, 95% CI = 0.9–1.0), Eysenck Personality Questionnaire-Extraversion (p < 0.001, OR = 1.2, 95% CI = 1.1–1.2), Eysenck Personality Questionnaire-Lie (p = 0.01, OR = 0.9, 95% CI = 0.9–1.0), and General Anxiety Disorder-7 (p = 0.02, OR = 1.1, 95% CI = 1.0–1.1) were independently associated with exhibiting hypomanic symptoms. The current study provided insights into hypomanic symptoms in Chinese postpartum women. We also found that extraversion and lie personality were significantly associated with an increased risk of hypomanic symptoms in postpartum women. It is urgent to arrange screening for women at risk of developing postpartum hypomania as soon as possible after giving birth and at regular intervals in the first 6 months to prevent the women developing psychological disorders such as depression and bipolar disorder later on. [ABSTRACT FROM AUTHOR]

Objective: To explore the effects of interpregnancy interval (IPI) on pregnancy outcomes of subsequent pregnancy. Methods: A multicenter retrospective study was conducted in 21 hospitals in China. Information of age, height, pre-pregnancy weight, IPI, history of diseases, complications of pregnancy, gestational age of delivery, delivery mode, and pregnancy outcomes of the participants were collected by consulting medical records of pregnant women who had two consecutive deliveries in the same hospital during 2011 to 2018. The participants were divided into 4 groups according to IPI:<18 months, 18-23 months, 24-59 months and ≥60 months. According to the WHO's recommendation, with the IPI of 24-59 months group as a reference, to the effects of IPI on pregnancy outcomes of subsequent pregnancy were analyzed. Stratified analysis was further carried out based on age, history of gestational diabetes mellitus (GDM), macrosomia, and premature delivery, to explore the differences in the effects of IPI on pregnancy outcomes among women with different characteristics. Results: A total of 8 026 women were included in this study. There were 423, 623, 5 512 and 1 468 participants in <18 months group, 18-23 months group, 24-59 months group and ≥60 months group, respectively. (1) The age, pre-pregnancy body mass index (BMI), history of cesarean section, GDM, gestational hypertension and cesarean section delivery rate of <18 months group, 18-23 months group, 24-59 months group and ≥60 months group were gradually increased, and the differences were statistically significant ( P <0.05). (2) After adjusting for potential confounding factors, compared with women in the IPI of 24-59 months group, the risk of premature delivery, premature rupture of membranes, and oligohydramnios were increased by 42% ( OR =1.42, 95% CI : 1.07-1.88, P =0.015), 46% ( OR =1.46, 95% CI : 1.13-1.88, P =0.004), and 64% ( OR =1.64, 95% CI : 1.13-2.38, P =0.009) respectively for women in the IPI≥60 months group. No effects of IPI on other pregnancy outcomes were found in this study ( P >0.05). (3) After stratified by age and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of oligohydramnios for women with advanced age ( OR =2.87, 95% CI : 1.41-5.83, P =0.004); and <18 months could increase the risk of premature rupture of membranes for women under the age of 35 ( OR =1.59, 95% CI : 1.04-2.43, P =0.032). Both the risk of premature rupture of membranes ( OR =1.58, 95% CI : 1.18-2.13, P =0.002) and premature delivery ( OR =1.52, 95% CI : 1.07-2.17, P =0.020) were significantly increased in the IPI≥60 months group. After stratified by history of GDM and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would lead to an increased risk of postpartum hemorrhage for women with a history of GDM ( OR =5.34, 95% CI : 1.45-19.70, P =0.012) and an increased risk of premature rupture of membranes for women without a history of GDM ( OR =1.44, 95% CI : 1.10-1.90, P =0.009). After stratified by history of macrosomia and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months could increase the proportion of cesarean section for women with a history of macrosomia ( OR =4.11, 95% CI : 1.18-14.27, P =0.026) and the risk of premature rupture of membranes for women without a history of macrosomia ( OR =1.46, 95% CI : 1.12-1.89, P =0.005). After stratified by history of premature delivery and adjusted for confounding factors, compared with women in the IPI of 24-59 months group, IPI≥60 months would significantly increase the risk of premature rupture of membranes for women without a history of premature delivery ( OR =1.47, 95% CI : 1.13-1.92, P =0.004). Conclusions: Both IPI≥60 months and <18 months would increase the risk of adverse pregnancy outcomes in the subsequent pregnancy. Healthcare education and consultation should be conducted for women of reproductive age to maintain an appropriate IPI when they plan to pregnant again, to reduce the risk of adverse pregnancy outcomes in the subsequent pregnancy.

This article focuses on the decision taken by Tibet Autonomous Region of China for issuing birth permits. In accord with Document No. 5/1984 of the Tibet Leading Group for Birth Planning, Birth Permits and One-Child Certificates will be issued separately and autonomously by the birth planning offices of all prefectures and cities, beginning with the second half of 1985. It will make population development conform to economic development in the various regions. The first year after having reached age twenty-four shall be reckoned as late birth age. All persons wanting to give birth beyond twenty-four years of age are not restricted by plan targets. After having been fined a one-time penalty of five hundred yuan by their prefectural or municipal birth-planning office, cases of rash births without approval from the birth-planning departments get a Birth Permit. The penalty sum can be paid into the birth-planning budget. In accord with the spirit of Document No. 15/1983 of the Tibet Party Committee, cadres, workers and staff, and their family members with household registration in the work units who are Tibetans or other minority nationals from the region, are permitted a second child. However, they must observe a birth interval of more than three years.

Animal life activities are rhythmic and affected by seasonal periodicity. Based on 9 years of observations, we estimated the reproductive parameters of a wild, but provisioned Yunnan snub-nosed monkey (Rhinopithecus bieti) group at Xiangguqing in Baimaxueshan National Nature Reserve, Yunnan Province, China. We observed 84 infants (43 males and 41 females) from 41 females between 2010 and 2018. We found the birth sex ratio was 1:1, the female age at first birth was 6.13 years and infant mortality was about 15.5%. Nine years of data showed that the maximum birth season lasted 126 days, and the average length per year was 98.57 ± 18.71 days. R. bieti,characterized by strictly seasonal reproduction, started giving birth on February 1, and this ended on June 7, with a peak reached from March 4 to March 11 (10th week). The mean birth date was March 20 (79.21 ± 29.54 days), and the median birth date was March 11 (71st day). The mean interbirth interval (IBI) was approximately 2 years, and the IBIs among females whose infants had survived for 1 year were found to be significantly longer than those found in females who lost their infant within 1 year. Comparing the reproduction parameters among Asian and African colobines, we concluded that Asian and African colobines tend to have an IBI of 2 years or more, females tend to give birth at the age of 5-6 years, Rhinopithecus species had a strict seasonal reproductive pattern concentrated in February to April. Seasonal changes in food resources and climatic factors may be the main reasons for the variation in reproductive parameters in intraspecific and interspecific comparisons of Asian and African colobines., (© 2019 S. Karger AG, Basel.)

The article takes a look on the family planning program in Shanghai County in China. It is argued that the development of the family planning program is brought by the existence of high population density in the county, and it has a major significant impact on the county's fertility and growth rates. Moreover, it cites that the main elements of fertility control are late marriage and childbearing, provision of contraceptive services and emphasis on fewer children with longer intervals between them.

This article focuses on government directive for unfolding birth planning throughout the Tibet autonomous region in China. The directive urged that cadres, workers and staff, and their family members from among the Tibetans or other minority nationalities should have only one child; two children were permitted, but there must be a birth interval of three years. For urban residents, one child was advocated; two children were permitted. For the masses of peasants and herdsmen in the central region, one or two children were advocated; three children were permitted; four should be controlled. For border regions, sparsely settled areas, and small minorities, no quota restrictions were introduced; but they should practice rational childbearing, better births, and better upbringing.

This article focuses on the circular issued by Tibet Autonomous Region Party Committee on birth control. The circular declared that birth control should be implemented mainly among cadres, workers and staff, and their children who are Han-Chinese, or hail from marriages between Han-Chinese and minority nationals. It advocated later births, longer birth intervals, and fewer children. The document also urged the establishment of birth-planning organs in all areas and the unfolding of propaganda for contraception. No birth-planning rules were envisaged for Tibetans or other minority nationals from Tibet. A first draft of the Provisional Birth-Planning Rules for Han-Chinese Cadres, Workers and Staff Working in Tibet was begun.

This article focuses on the circular issued by the Tibet Autonomous Region Party Committee for implementing the Party Central Committee Document No. 7/1984 for birth planning. The document decreed that Han-Chinese cadres, workers and staff who have their first child after having reached twenty-four years of age and who hold a one child certificate get one year of maternity leave. All Tibetan couples who are cadres, workers and staff from the region, of whom both spouses voluntarily have only two children for their whole life, and who pledge not to have a third child, can get four months of maternity leave. Their wages during the period of maternity leave are paid in full, and the medical expenses for their children can be reimbursed according to regulations of the division of finances. Among the masses of peasants and herdsmen, there should be propaganda on population theory and on the advantages of having children in a planned way, popularization of scientific knowledge on contraception, better births, and better upbringing, and gradual introduction of fewer births, better births, and better upbringing, in order to raise population quality.

The article presents information on rules, dated September 1979, on problems related to birth planning. The rules directed that a couple should at best have only one child, at most two children and birth interval should be four years.

Background: The study evaluated effects of interpregnancy interval (IPI) on neonatal outcomes after mifepristone-induced abortion in the first pregnancy., Study Design: This observational cohort study, conducted from 1998 to 2001 at antenatal clinics in Shanghai, Beijing, and Chengdu, China, included 4682 nulliparous women with one mifepristone-induced abortion in their first pregnancy, who were enrolled and followed up until delivery. We compared neonatal outcomes among women with different IPIs between their mifepristone-induced abortion and subsequent pregnancy., Results: When compared to IPI of 18-24 months, there was an increased risk of the neonate being small for gestational age (SGA) [adjusted odds ratio (aOR): 2.01; 95% confidence interval (CI): 1.04-3.88] when IPI was <6 months; this risk was greater among women without a curettage history after abortion (aOR: 2.49; 95% CI: 1.13-5.50). The associations between IPI and preterm delivery (<37 weeks), low birth weight (<2500 g), mean birth weight and ponderal index were not statistically significant., Conclusions: The results indicate that an IPI <6 months after one mifepristone-induced abortion in first pregnancy is associated with an increased risk of SGA in the subsequent pregnancy., (Copyright © 2013 Elsevier Inc. All rights reserved.)

We examine the effects on adult and old age mortality of childhood living arrangements and other aspects of family context in early life. We focus on features of family context that have already been shown to be associated with infant or child mortality in historical and developing country populations. We apply discrete-time event-history analysis to longitudinal, individual-level household register data for a rural population in northeast China from the eighteenth and nineteenth centuries. Loss of a mother in childhood, a short preceding birth interval, and high maternal age were all associated with elevated mortality risks later in life. Such effects persist in a model with fixed effects that account for unobserved characteristics of the community and household. An important implication of these results is that in high-mortality populations, features of early-life family context that are associated with elevated infant and child mortality may also predict adverse mortality outcomes in adulthood.

The timing of marriages, first birth interval and the prevalence of premarital conception (PMC) among women of successive birth cohorts in one rural county in Yunnan, China, were examined. Detailed pregnancy histories were collected for 1,336 women aged 15-64 years using a Life History Calendar. The rising marriage age and shorter first birth interval correspond to over-all changes in the Chinese society over the same time period. The mean age at first marriage for women born before 1950 was just below 20, and 22.5 among women born 1976-1980. The later marriage age was partly offset by the dramatic shortening of the first birth interval from over 30 months in the oldest cohort to 11-12 months in the youngest. One explanation of the shortening of the first birth interval may be the increase in premarital conception. Among the young women in our study almost one-third of first pregnancies were conceived before marriage.

Data from a cohort study of 7,336 newly married fertile couples conducted between 1987 and 1995 were used to analyze contraceptive method choice, switching, and discontinuation in two districts of Shanghai. Twelve percent of couples reported that they had had sexual intercourse before marriage. Only one-third of those exposed to premarital risk of conception were protected by some form of contraception, mostly by withdrawal and periodic abstinence. As a consequence, a majority of these couples conceived, prompting rapid marriage in most cases and induced abortion among one-fourth of them. After marriage, about half of the couples used contraceptives to postpone the birth of their first child, but of these, 40 percent experienced an unintended pregnancy. Method choice was dominated by condoms, withdrawal, and abstinence. After the birth of their first child, almost all couples (98 percent) adopted contraceptives, but one-third of them used ineffective methods. Failure and discontinuation rates were high, giving rise to a high incidence of induced abortion. Increasing numbers of couples switched to the IUD, and this was the preferred method for the majority by the third year following childbirth. These results suggest that wider method choice that includes hormonal contraceptives should be provided to meet couples' needs in Shanghai and that the family planning program's attention should be focused specifically on sexually active unmarried individuals and on the availability of postpartum services.

This study examines the delay between first marriage and first live birth in China among a sample of women who married between 1980 and 1992. Most couples in China only use contraception after the first child is born. Most sample women had their first child within 2 years of marriage. However, there are significant rural-urban differences in the first birth interval, indicating that there was most probably deliberate fertility regulation after marriage among many urban couples. Survival analysis shows that place of residence, level of education, age at first marriage and marriage cohort affect the first birth interval.