Changes in fertility intention among married Chinese couples with two children during COVID-19: a cross-sectional study.

Background: A three-child policy was implemented in China to stimulate a rise in fertility levels and coincided with the COVID-19 pandemic. Data suggested that COVID-19 has a negative impact on fertility intention.

Aim: To describe married couples' changes in intention to have a third child during the COVID-19 pandemic and determine factors associated with altered intentions.

Methods: An online survey was conducted in October 2021, including sociodemographic characteristics, change of intention to have a third child after the COVID-19 pandemic outbreak, reasons for increased or decreased intention, and the Fertility Intention Scale (FIS). Bivariate and multivariable logistic regression were used to test the potential factors associated with changes in intention.

Results: A total of 1308 participants provided responses. Following the COVID-19 outbreak, 35.8% of participants decreased their third-child intention, while 2.8% of participants increased their third-child intention. Males (aOR 1.90, 95% CI 1.42 to 2.54), youngsters (aOR 1.77, 95% CI 1.08 to 2.93) and those living in Estern China (aOR 2.12, 95% CI 1.13 to 3.98) were more likely to decrease their third-child intention. Perceived risk (aOR 1.07, 95% CI 1.03 to 1.10) and policy support (aOR 1.06, 95% CI 1.03 to 1.09) as measured on the FIS decreased couples' intention to have a third child. Social support (aOR 0.94, 95% CI 0.91 to 0.98) as measured on the scale protected participants from decreased intention.

Conclusions: During severe public health emergencies, strong prevention and control policies, together with enhancing support from partners and healthcare professionals for women, are necessary to improve intentions to give birth.