The willingness of families to have children plays a crucial role in long-term population development. Currently, China is experiencing a significant risk of low fertility, with low fertility becoming the prevailing trend.
Under the macro background of the comprehensive liberalization of the ''three-child policy'', this study aims to analyze the willingness of the population to have children and the varying influencing factors across different age groups and establish a foundation for developing pertinent fertility policies by elucidating the concerns about fertility held by various age groups.
The data used in this study was sourced from the 2021 China Comprehensive Social Survey (CGSS). This study selected a population aged 20-44 years old, and after excluding missing variables, a total of 2 525 samples were included, including 1 444 females. A study on the entire population is conducted in order of age from young to old, with one group every 5 years old, for a total of 5 groups; Research on women was divided into two groups based on age groups of 34 and 35 and above. Using multiple variables from three dimensions of personal characteristics, family characteristics, and attitudes as possible influencing factors, an ordered Logistic regression model was used to analyze the factors affecting fertility intention in the entire population and only for women.
The number of people willing to have two children accounted for 59% of the total survey population (1 491/2 525), and the group under 34 years old had a higher willingness to have zero children compared to the group over 35 years old (P<0.05). The results of Logistic regression analysis showed that, among individual characteristic variables, individuals with better health conditions were more likely to have a higher willingness to have children, which was significant in the population aged 35-39 and women over 35 years old (P<0.05). In the family characteristic variables, people with a larger family size were more likely to have a higher willingness to have children, which was significant in the population aged 25 and above and women over 35 years old (P<0.05). There was a higher likelihood of having a stable partner with a higher willingness to conceive, which was significant in women under 34 years old (P<0.05). In the concept attitude variables, all variables of the 20-24 were group were significant, and the results showed diversity in other age groups.
The current mainstream fertility intention is to have two children, and the fertility intention of young people (under 34 years old) is relatively high. Better physical health and larger family size are more prominent in the age group of 35 and above, and attitudes have a stronger impact on fertility intentions, with significant age differences. It is recommended to pay attention to the reproductive views of different age groups, strengthen family, social, and policy support, attach importance to women's physical health, and provide medical support for childbirth.
The association between female reproductive factors and cognitive function was unclear, there still lack studies on female reproductive factors and subjective cognitive function.
Exploring the relationship between female reproductive factors and subjective or objective cognitive function, and providing theoretical basis for the prevention and intervention of cognitive decline and dementia.
The baseline survey was conducted in July 2023 in Pingyin, Jinan (in three townships). After using a multi-stage cluster random sampling method, 2 165 valid participants aged 45-70 were recruited at baseline. We collected sociodemographic data, medical histories, lifestyle factors, and female reproductive factors through a self-designed comprehensive questionnaire. The subjective and objective cognitive function of participants were evaluated by the Subjective Cognitive Decline-Questionnaire 9 (SCD-Q9) and Montreal Cognitive Assessment Scale-Basic (MoCA-B), respectively. In addition, we also collected anthropometric data (included height and weight) and blood samples (to get APOE e4 alleles). Multivariate Logistic regression and Local weighted regression (Loess) were used to analyze the influence of female reproductive factors on cognitive function and to detect potential nonlinear relationships between age at menarche, age at menopause, length of reproductive period and MoCA-B scores.
This study was based on a baseline population and included 1 044 postmenopausal women. The prevalence of abnormal SCD-Q9 scores was 48.37% (505/1 044), while the prevalence of abnormal MoCA-B scores was 67.43% (704/1 044). Women who had 3 or more children had a lower risk of subjective cognitive decline compared with those who had 1 or fewer children (OR=0.59, 95%CI=0.36-0.98). Women with a breastfeeding duration <6 months had a higher risk of subjective cognitive decline compared with those with a breastfeeding duration of 6-12 months (OR=3.69, 95%CI=1.03-13.16). Age at menarche >18 years (OR=1.91, 95%CI=1.09-3.35), age at menopause ≤45 years (OR=1.61, 95%CI=1.00-2.62), and reproductive period ≤30 years (OR=1.56, 95%CI=1.07-2.29) or >40 years (OR=2.22, 95%CI=1.05-4.72) were all associated with poorer objective cognitive function (P<0.05). Loess analysis revealed an inverted "J-shaped" relationship between age at menarche, age at menopause, reproductive period and MoCA-B scores.
Women with more children (≥3) have a lower risk of subjective cognitive decline and women with shorter breastfeeding duration (<6 months) have a higher risk of subjective cognitive decline. Age at menarche >18 years, early menopause (≤45 years), and excessively long or short reproductive periods are all associated with poorer objective cognitive function. We should pay attention to the influence of female reproductive factors on cognitive function in order to delay the process of cognitive decline.
The rate of participation in standard pregnancy health care in China is gradually increasing, highlighting the imbalance and insufficiency in women's and children's health development between urban and rural areas. The potential of rural women's self-management as the cornerstone of pregnancy health care has not been fully utilized.
To examine the current status of standard pregnancy health care among rural women, assess their level of self-management behavior, and identify the factors influencing their self-management behavior in pregnancy health care.
The research was conducted from January to August 2023, involving rural women in Suihua City and Daqing City in Heilongjiang Province, as well as Changchun City in Jilin Province, all selected through convenience sampling. Various tools such as the Basic Information Questionnaire, Maternal Self-Management Scale, A5-item Short Form of the Edinburgh Postnatal Depression Scale (EPDS-Dep-5), and Maternal Social Support Scale (MSSS) were employed to gather data. Data in relation to the present condition of standard pregnancy health care among rural women were counted. The self-management behavior scores of different characteristics of rural women in pregnancy health care were compared. Multiple linear regression was used to assess the factors that impact rural women's self-management behavior in pregnancy health care.
A total of 493 questionnaires were distributed, and 470 valid questionnaires were collected, with a valid questionnaire collection rate of 95.33%. The findings revealed that 218 rural women (46.4%) underwent pre-pregnancy checkups, with 388 (82.6%) having their first checkups within 12 weeks. There were 303 cases (64.5%) where obstetric examinations took place in medical and health institutions at the county level or higher. Of 276 cases (58.7%), the number of obstetric examinations satisfied the requirements for the respective pregnancy week. However, only 103 cases (21.9%) adhered to the required number of obstetric examination items for the pregnancy week. The average score for self-management of health care during pregnancy was (70.18±16.42). The scoring indicators for each dimension, in descending order, were medical compliance behavior (79.75%), routine life behavior management (77.33%), self-protection behavior (76.73%), and fetal monitoring behavior management (70.43%). The findings from the multiple linear regression analysis indicated that the distance of family residence from the closest antenatal care facility (B=0.732, 95%CI=0.139-1.325), gestational week (B=-1.336, 95%CI=-2.119 to -0.553), pregnancy complications (B=3.776, 95%CI=1.532-6.019), risk of depression during pregnancy (B=-0.356, 95%CI=-0.663 to -0.049), and social support status (B=2.635, 95%CI=2.508-2.762) were identified as significant factors influencing the self-management behaviors of pregnancy health care among rural women (P<0.05) .
Rural women exhibited low rates of participation and eligibility for standardized pregnancy health care, along with moderate scores for self-management behaviors related to pregnancy health care. The distance of family residence from the nearest antenatal care facility, gestational week, pregnancy comorbidities, risk of depression during pregnancy, and social support were found to be the factors influencing the self-management behaviors of pregnancy health care among rural women. It is recommended that health care providers at all levels focus on rural women during pregnancy, standardize their pregnancy health care behaviors, enhance their self-management skills, and establish a scientifically sound, cost-effective, simple, and easily operable self-management intervention model for pregnancy health care among rural women.
