Fertility anxiety among Chinese women in the context of fertility policy relaxation: A systematic literature review

Abstract

Against the backdrop of China's comprehensive relaxation of fertility policies, the anxiety experienced by Chinese women during fertility decision-making is widely discussed. To outline the current state of research on Chinese women's fertility anxiety, we systematically reviewed and analyzed 50 relevant studies published between 2015 and 2024, focusing on the conceptualization of fertility anxiety, assessment methods, influencing factors, and theoretical frameworks. The findings indicated that fertility anxiety is a multidimensional psychological state encompassing cognitive anxiety (emerging from rational evaluation of potential consequences of fertility decisions) and emotional anxiety (shaped by sociocultural norms, gender role expectations, and available social support). Recently, research on fertility anxiety has begun to integrate both cognitive and emotional dimensions, which is crucial for designing effective intervention strategies and policy response mechanisms. However, unified and standardized multidimensional measurement tools are still lacking. Studies have often combined quantitative and qualitative methods to indirectly depict the characteristics of fertility anxiety. Regarding influencing factors, research has demonstrated the interconnections between individual attributes, family background, the sociocultural environment, and policy systems, which jointly shape women's fertility anxiety. Various theoretical frameworks have been employed to explain the complex these factors, highlighting the multifaceted and multilayered nature of fertility anxiety. Future research should further advance indigenous theory development and cross-cultural comparison, deepen the tracking of dynamic mechanisms of fertility anxiety, and develop context-sensitive and ecologically valid assessment tools to reveal the interactions among individual, social, and cultural factors, thereby providing a theoretical basis for optimizing policy design and constructing multi-level support systems.