Explore the vast range of titles available.

Background Korean government has established various policies to counter the low fertility rate since the mid-2000s, but it still has the lowest fertility rate among OECD member countries. This study investigated the relationship between changes in the Korean fertility rate and policies to encourage fertility. Methods This study utilized data of the total fertility rate of 250 local governments between 2014 and 2018, and a casebook of local government birth promotion policies. The dependent variable was fertility rate, and the independent variable was fertility promotion policy. Using SPSS 25.0 and M-plus 8.0 programs, descriptive statistical analysis and latent growth modeling were conducted. An unconditional quadratic function change model was selected as a final model of this study. Results The average of the initial fertility rate and the linear rate of change in the Korean fertility rate, and the rate of change of the quadratic function were all statistically significant, meaning that the fertility rate of decline increases over time. Also, the linear rate of change and the quadratic function change rate were significant, showing significant differences in the initial level and rate of change of the fertility rate between local governments. Among fertility policies, only the in-kind policy had a significant effect on the initial value of the fertility rate, meaning that the higher the number of in-kind policies, the higher the fertility rate. Conclusion This study is crucial as it examined the changes in the fertility rate of Korean local governments as well as the policy factors affecting the fertility rate at a quantitative level.

Beginning in 2016, all couples in China were allowed to have two children without any restrictions. This paper provides population and economic projections under five shared socioeconomic pathways (SSPs) and three fertility policies. By replacing the one‐child policy with the two‐child policy, the population is predicted to continue growing until 2025–2035, with a peak of approximately 1.39–1.42 billion, and then to decline under four SSPs, with the exception of the fragmented world SSP3. As a result, the two‐child policy will lead to mitigation of the pressure from labor shortages and aging problems to a certain extent. In addition, an increase in working‐age people with higher education level relative to projections based on the one‐child policy will lead to an increase in gross domestic product by approximately 38.1–43.9% in the late 21st century. However, labor shortages and aging problems are inevitable, and the proportion of elderly in China will be greater than 14% and 21% by approximately 2025 and 2035, respectively. Full liberalization of fertility is expected to reduce the share of elderly people by 0.7–1.0% and to lead to an increase in gross domestic product by 5.3–6.7% relative to the two‐child policy in the late 21st century. The full liberalization of fertility policies is recommended, supplemented by increases in pension and child‐rearing funds, improvement in the quality of health services for females and children, and extension of compulsory education to meet the needs of an aged society. Plain Language Summary The one‐child policy in China has been replaced by the two‐child policy since 2016. What might the population and economy change if the one‐child policy is continued in the 21st century? What can China benefit from the fertility policy changes? Is it necessary to allow people to choose their family size in China? We conducted multipopulation policies and multisocioeconomic development pathways combined analysis to explore the effects of fertility policy changes on population and economy in China. We found that population size by the late 21st century might be 28% less than that in 2010 at the one‐child policy, and share of elderly (aged 65+) might be 49%. The implementation of the two‐child policy can mitigate the labor shortages and aging problems to a certain extent, and the increased working‐age population with higher education level can lead to a 38.1–43.9% increase in gross domestic product in the late 21st century. A further 0.7–1.0% reduction in elderly share of the total population and 5.3–6.7% increase in gross domestic product is projected in the late 21st century at the “full relaxation” policy. We believe that introduction of effects from fertility policy changes on socioeconomy can deliver useful information to decision makers. Key Points The integrated effects of population policies and socioeconomic pathways on the population structure and economy are explored The population bust in China caused by the one‐child policy will be relieved after the two‐child policy, as indicated by all the SSPs Full relaxation of fertility control is recommended with the simultaneous implementation of other social policies (e.g., pension funds)

Population aging is creating serious challenges for the sustainability of China’s pension system. To mitigate the adverse impact of the demographic shift, China has recently introduced fertility and retirement policy reforms. The research presented in this paper primarily evaluates the impacts of recent reforms on the financial sustainability of China’s Urban Employees’ Pension Plan (UEPP). By using the Leslie matrix and actuarial models, the financial sustainability of the UEPP from 2019 to 2070 is projected and evaluated under a set of assumed policy reform scenarios. The results indicate that an imbalance in the pension fund would occur in the early 2020s and then expand under existing policies. Fertility adjustment, retirement delay, or combination reforms would not fundamentally solve this financial crisis in the long term. When 100% of couples have a second child and the retirement age is increased to 65, the current and accumulated pension deficits would drop by 50.05–67.56% and 35.88–54.23% between 2040 and 2070, respectively. Supplementary policy measures should be designed to encourage childbearing and retirement delay, including family support policies and top-designed pension system reform policies.

Between 2016 and 2018, we observe in Uruguay a steep decline of almost 20 percent in the number of total births, leading to the collapse of the adolescent fertility rate after decades of relative stagnation. We estimate the quantitative contribution on birth rates, especially teen births, of a policy of expanded availability of subdermal contraceptive implants. We exploit the expansion schedule of a large‐scale policy of free‐of‐charge access to subdermal implants in the country's public health system through an event study to capture causal effects. We use detailed birth administrative records for the past 20 years. We document an average reduction of 3 percent in the birth rate in public health facilities across the two years after the policy was implemented in each department. These reductions were notably higher among teens and first births. Although changes in women's fertility decisions are a multicausal phenomenon, we claim that the expanded availability of subdermal contraceptive implants accounted for one‐third of the teen and young women's birth collapse.

Background: The objective of the current study was to evaluate the trend and risk factors of antenatal depression (AD) among Chinese women in the third trimester of pregnancy, taking into account the impact of multiple fertility policy adjustments and economic development in China. Method: A repeated cross‐sectional study design was used. A total of 3404 pregnant women at 30–42 weeks’ gestation were recruited from the two largest maternity hospitals in Zhejiang Province, China, between 2016 and 2021. Results: The prevalence of AD among women in their third trimester of pregnancy had significantly increased from 31.8% to 60.6% ( p   < 0.001) from 2016 to 2021. Pregnant women aged between 18 and 24 years reported the highest prevalence of AD. Those aged between 25 and 34 years (odds ratio [OR], 0.788; 95% confidence interval [CI]: 0.630–0.985), with a better self‐reported health status (OR, 0.929; 95% CI: 0.922–0.936) and higher perceived social support (OR, 0.948; 95% CI: 0.940–0.955), reported a lower prevalence of AD. Pregnant women who were housewives (OR, 1.399; 95% CI: 1.078–1.817), had an introverted personality (OR, 1.324; 95% CI: 1.119–1.568), and had experienced an unplanned pregnancy (OR, 1.303; 95% CI: 1.098–1.547) reported a higher prevalence of AD. Conclusions: The significant increase in the prevalence of AD from 2016 to 2021 has caused concern in society. To improve the aforementioned situation, it is imperative to implement further initiatives to address the challenges faced by pregnant women, especially those who are housewives, have introverted personalities, and have experienced unplanned pregnancies.

China has been experiencing below-replacement fertility rates for decades prompting concerns about the rapid aging of the population and a dwindling labour supply. This paper examines the effects of micro-level and macro-level factors on fertility intentions in China from 2010 to 2021. The analyses utilize repeated cross-sectional data from the nationally representative Chinese General Social Survey, focusing on adults of childbearing age. A multilevel logistic regression approach is employed. The findings indicate that economic status, at both the individual and provincial levels, significantly shapes individuals’ intentions regarding having two or more children. Those with higher individual economic status are more inclined to have multiple children, while individuals residing in provinces with higher mean incomes are less likely to have two or more children compared to those in provinces with lower mean incomes. Notably, the long-term impact of the one-child policy on intentions to have two or more children is particularly pronounced for urban residents and individuals from provinces that rigorously implemented the one-child policy. Additionally, the study identifies spatial differentiation in fertility intentions.

This editorial seeks to define fragile pronatalism by highlighting why pronatalism in the examined Central and Eastern European post‐socialist countries should be considered fragile. Moreover, it aims to map desirable future changes in fertility policies in the region. Following a brief presentation of the articles contained in this thematic issue, our concluding thoughts complete this editorial.

This review highlights the challenges, priority areas of research and planning, strategies for regulation of services and the need to develop guidelines and laws for fertility treatments during mid-life. The success rate of all treatments is poor in advanced age women because of declining ovarian reserve and natural fertility. There is often a need of third-party involvement which has its own ethical, legal and medical issues. Welfare of children born to older women and early death of parents are important concerns. Most of the new techniques such as the pre-implantation genetic diagnosis, oocyte augmentation, use of stem cells or artificial gametes, ovarian tissue preservation and ovarian transplantation are directed to improve, preserve or replace the declining ovarian reserve. These techniques are costly and have limited availability, safety and efficacy data. Continued research and policies are required to keep pace with these techniques. The other important issues include the patients' personal autonomy and right of self-determination, welfare of offspring, public vs. private funding for research and development of new technologies vs. indiscriminate use of unproven technology. It is important that mid-life fertility is recognized as a distinct area of human reproduction requiring special considerations.

Background Previous studies have shown that the incidence of ectopic pregnancy (EP) is increasing in China. It is unclear, however, whether the incidence of EP has changed after the implementation of the universal two-child policy in the context of China’s aging population and declining fertility rate. Methods Data concerning EP from January 2011 to December 2020 were collected from the hospital’s electronic medical records, which included the annual number of delivery, caesarean section rate, ectopic pregnancies, treatment of tubal pregnancy, and average costs and length of hospitalization. Trends of the EP incidence were analysed and annual percentage change (APC) was calculated using connected point regression analyses. Results A total of 9499 cases of EP were collected, among which caesarean scar pregnancy (CSP) accounts for the second highest (6.73%). The EP per 100 deliveries revealed a downward trend, from 7.60% in 2011 to 4.28% in 2020 with an APC of -1.87 ( P  < 0.05). The maternal age was increased, especially after the implementation of the universal two-child policy. The constituent ratio for the advanced maternal age (≥ 35) and the caesarean section rate, but not the CSP, were also increased. Laparoscopic salpingectomy was the main surgical method, whereas the adoption of laparotomy and laparoscopic salpingostomy was decreasing year by year. Conclusions Although no obvious effect of the two-child policy on EP has been observed under the conditions of this study, the change in EP especially in advanced-age women after the policy implementation needs further evaluation. A decreased caesarean section rate, in primipara is beneficial to reducing the CSP.

Abstract Background: With an increasing proportion of multiparas, proper interpregnancy intervals (IPIs) are urgently needed. However, the association between IPIs and adverse perinatal outcomes has always been debated. This study aimed to explore the association between IPIs and adverse outcomes in different fertility policy periods and for different previous gestational ages. Methods: We used individual data from China's National Maternal Near Miss Surveillance System between 2014 and 2019. Multivariable Poisson models with restricted cubic splines were used. Each adverse outcome was analyzed separately in the overall model and stratified models. The stratified models included different categories of fertility policy periods (2014-2015, 2016-2017, and 2018-2019) and infant gestational age in previous pregnancy (<28 weeks, 28-36 weeks, and ≥37 weeks). Results: There were 781,731 pregnancies enrolled in this study. A short IPI (≤6 months) was associated with an increased risk of preterm birth (OR [95% CI]: 1.63 [1.55, 1.71] for vaginal delivery [VD] and 1.10 [1.03, 1.19] for cesarean section [CS]), low Apgar scores and small for gestational age (SGA), and a decreased risk of diabetes mellitus in pregnancy, preeclampsia or eclampsia, and gestational hypertension. A long IPI (≥60 months) was associated with an increased risk of preterm birth (OR [95% CI]: 1.18 [1.11, 1.26] for VD and 1.39 [1.32, 1.47] for CS), placenta previa, postpartum hemorrhage, diabetes mellitus in pregnancy, preeclampsia or eclampsia, and gestational hypertension. Fertility policy changes had little effect on the association of IPIs and adverse maternal and neonatal outcomes. The estimated risk of preterm birth, low Apgar scores, SGA, diabetes mellitus in pregnancy, and gestational hypertension was more profound among women with previous term births than among those with preterm births or pregnancy loss. Conclusion: For pregnant women with shorter or longer IPIs, more targeted health care measures during pregnancy should be formulated according to infant gestational age in previous pregnancy.