Regional disparities and factors associated with third-child fertility intentions among reproductive-age population in Eastern China post the three-child policy: a systematic review and meta-analysis
Abstract
Background and purposeFertility decline and population aging have become major demographic challenges in China. This systematic review and meta-analysis aimed to estimate the prevalence of third-child fertility intention (TCFI) among reproductive-age populations and further childbearing intention (FCI) among participants with two children in Eastern China, and to examine associated factors.MethodsWeb of Science, Embase, PubMed, Cochrane Library, CNKI, VIP, CBM, and Wanfang were searched for cross-sectional studies published from 31 May 2021 to 23 August 2026. Two reviewers independently performed study selection, data extraction, and quality assessment. Random-effects meta-analyses were used to estimate pooled proportions and crude odds ratios (ORs) with 95% confidence intervals (CIs).ResultsEighteen studies involving 31,636 participants were included. The pooled prevalence of TCFI was 6.6% (95% CI: 4.7%−9.0%), and that of FCI was 10.2% (95% CI: 7.4%−13.8%). Subgroup analyses by geographical region, population characteristics, and sample size did not identify a clear source of heterogeneity. Older age, education at or below high school level, rural residence, being married, and lack of pension insurance were associated with higher TCFI, whereas public official status was associated with lower TCFI. Medical insurance was not significantly associated with TCFI. For FCI, no statistically significant associations were identified for age, sex composition of the existing two children, or public official status; however, only a limited number of studies contributed to these analyses.ConclusionTCFI and FCI remained low in Eastern China after implementation of the three-child policy. Several demographic and socioeconomic factors were associated with TCFI, whereas evidence regarding factors associated with FCI remained limited and inconclusive. Given the substantial heterogeneity and limited evidence for FCI-related factors, these findings should be interpreted with caution.Registryhttps://inplasy.com/, INPLASY(INPLASY202650095).
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BibTeX
@article{zhou2026regional,
title = {{Regional disparities and factors associated with third-child fertility intentions among reproductive-age population in Eastern China post the three-child policy: a systematic review and meta-analysis}},
author = {Xiaonan Zhou and Jianchao Si and Jun Hao and Xiaohan Ye and Xiayu Lyu and Bin Lin and Jianguo Zhou},
journal = {Frontiers in Public Health},
year = {2026},
month = nov,
doi = {10.3389/fpubh.2026.1909324},
url = {https://www.frontiersin.org/articles/10.3389/fpubh.2026.1909324},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Regional disparities and factors associated with third-child fertility intentions among reproductive-age population in Eastern China post the three-child policy: a systematic review and meta-analysis
AU - Xiaonan Zhou
AU - Jianchao Si
AU - Jun Hao
AU - Xiaohan Ye
AU - Xiayu Lyu
AU - Bin Lin
AU - Jianguo Zhou
PY - 2026
DA - 2026/11/04
JO - Frontiers in Public Health
DO - 10.3389/fpubh.2026.1909324
UR - https://www.frontiersin.org/articles/10.3389/fpubh.2026.1909324
AB - Background and purposeFertility decline and population aging have become major demographic challenges in China. This systematic review and meta-analysis aimed to estimate the prevalence of third-child fertility intention (TCFI) among reproductive-age populations and further childbearing intention (FCI) among participants with two children in Eastern China, and to examine associated factors.MethodsWeb of Science, Embase, PubMed, Cochrane Library, CNKI, VIP, CBM, and Wanfang were searched for cross-sectional studies published from 31 May 2021 to 23 August 2026. Two reviewers independently performed study selection, data extraction, and quality assessment. Random-effects meta-analyses were used to estimate pooled proportions and crude odds ratios (ORs) with 95% confidence intervals (CIs).ResultsEighteen studies involving 31,636 participants were included. The pooled prevalence of TCFI was 6.6% (95% CI: 4.7%−9.0%), and that of FCI was 10.2% (95% CI: 7.4%−13.8%). Subgroup analyses by geographical region, population characteristics, and sample size did not identify a clear source of heterogeneity. Older age, education at or below high school level, rural residence, being married, and lack of pension insurance were associated with higher TCFI, whereas public official status was associated with lower TCFI. Medical insurance was not significantly associated with TCFI. For FCI, no statistically significant associations were identified for age, sex composition of the existing two children, or public official status; however, only a limited number of studies contributed to these analyses.ConclusionTCFI and FCI remained low in Eastern China after implementation of the three-child policy. Several demographic and socioeconomic factors were associated with TCFI, whereas evidence regarding factors associated with FCI remained limited and inconclusive. Given the substantial heterogeneity and limited evidence for FCI-related factors, these findings should be interpreted with caution.Registryhttps://inplasy.com/, INPLASY(INPLASY202650095).
SN - 2296-2565
ER -