# Fertility intention and its determinants of childbearing-age population in China after the three-child policy: a systematic review and meta-analysis

## TL;DR

This study reviews fertility intentions in China after the three-child policy and identifies factors influencing the willingness to have more children.

## Contribution

The study provides a meta-analysis of fertility determinants in China post-three-child policy, offering insights for policy design.

## Key findings

- The pooled prevalence of third-child fertility intention was 7.6%, and willingness to have another child was 12.7%.
- Factors like higher income and ethnic minority status were linked to higher fertility intentions.
- Policies targeting economic and healthcare support may help increase fertility rates.

## Abstract

China’s sustained fertility decline has intensified population contraction and ageing. Following the rollout of the three-child policy, clarifying fertility intentions among the childbearing-age population and their determinants is crucial for effective policy design and fertility promotion.

We conducted a systematic search of PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and Chinese Biomedical Literature Database. We included in the analysis studies published from 31 May 2021 to 10 May 2025 that examined third-child fertility intention (TCFI) and its determinants among the childbearing-age population in China. We used the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies to assess the quality of studies. Further, we estimated pooled prevalence with random-effects models.

A total of 37 studies were included in the analysis (n = 113 009 participants). The pooled prevalence of TCFI and willingness to have another child (WHAC) were 7.6% and 12.7%. Factors associated with higher TCFI included age >35 years, male sex, education at or below high school level, monthly personal income >CNY 2000, ethnic minority status, having at least one non-only-child spouse, and having no pension insurance. For WHAC, remarriage and good self-assessed health were significant determinants.

Both TCFI and WHAC remain low in China’s childbearing-age population. Enhancing childcare subsidies, strengthening medical security, and addressing core economic constraints such as housing and education may help raise fertility intentions.

PROSPERO: CRD420251036086.