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Third-child fertility intention stays low at 6.6% in Eastern China after policy shiftFertility intentions remain low in Eastern China after policy changes

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Key Takeaway
Recognize that third-child fertility intention remained low (6.6%) in Eastern China post-policy.

This systematic review and meta-analysis assessed fertility intention in the reproductive-age population of Eastern China after implementation of the three-child policy, drawing on a pooled sample of 31,636. It is a synthesis of prevalence and associated-factor data rather than a primary trial.

The pooled prevalence of third-child fertility intention (TCFI) was 6.6% (95% CI: 4.7% to 9.0%). Among participants who already had two children, the prevalence of further childbearing intention (FCI) was 10.2% (95% CI: 7.4% to 13.8%).

Factors associated with higher TCFI included older age, education at or below high school level, rural residence, being married, and lack of pension insurance. Public official status was associated with lower TCFI. Medical insurance was not significantly associated with TCFI. The authors note that evidence regarding factors associated with FCI remained limited and inconclusive.

The authors acknowledge substantial heterogeneity across the included evidence and limited data on FCI-related factors, and they caution that findings on factors associated with FCI should be interpreted with caution. Funding sources and conflicts of interest were not reported.

For clinicians, the synthesis indicates that TCFI and FCI remained low in Eastern China after the three-child policy was implemented. The associated-factor findings are observational in nature and should not be read as causal, and the heterogeneity limits firm conclusions about which groups to prioritize.

Families in Eastern China are facing a complex reality regarding their future. Even after the introduction of a three-child policy, the desire to expand the family remains low. A large study of over 31,000 people found that only about 6.6% of those surveyed intended to have a third child.

Several factors influence these decisions. People who were older, lived in rural areas, had less education, or lacked pension insurance were more likely to want a third child. On the other hand, those who were public officials were less likely to plan for another child.

While the data shows a clear picture for those wanting a third child, the evidence for why people with two children might want more is less clear. The researchers noted that because of differences in the data, we should be cautious when looking at the specific reasons for further childbearing intentions.

What this means for you:
Only 6.6% of parents in Eastern China intend to have a third child despite new policies.

Common questions

How many people plan to have a third child?

The study found that the prevalence of third-child fertility intention was 6.6% among the population surveyed in Eastern China. This means a relatively small number of people intended to have a third child despite the changes in policy.

What factors make a person more likely to want a third child?

People were more likely to want a third child if they were older, lived in rural areas, had an education at or below high school level, were married, or lacked pension insurance. These specific factors were linked to a higher intention to have a third child.

What factors make a person less likely to want a third child?

The study found that having a public official status was associated with a lower intention to have a third child. However, having medical insurance did not have a significant impact on whether a person wanted to have a third child.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedNov 2026
View Original Abstract ↓
Fertility decline and population aging have become major demographic challenges in China. This systematic review and meta-analysis aimed to estimate the prevalence of third-child fertility intention (TCFI) among reproductive-age populations and further childbearing intention (FCI) among participants with two children in Eastern China, and to examine associated factors. Web of Science, Embase, PubMed, Cochrane Library, CNKI, VIP, CBM, and Wanfang were searched for cross-sectional studies published from 31 May 2021 to 23 August 2026. Two reviewers independently performed study selection, data extraction, and quality assessment. Random-effects meta-analyses were used to estimate pooled proportions and crude odds ratios (ORs) with 95% confidence intervals (CIs). Eighteen studies involving 31,636 participants were included. The pooled prevalence of TCFI was 6.6% (95% CI: 4.7%−9.0%), and that of FCI was 10.2% (95% CI: 7.4%−13.8%). Subgroup analyses by geographical region, population characteristics, and sample size did not identify a clear source of heterogeneity. Older age, education at or below high school level, rural residence, being married, and lack of pension insurance were associated with higher TCFI, whereas public official status was associated with lower TCFI. Medical insurance was not significantly associated with TCFI. For FCI, no statistically significant associations were identified for age, sex composition of the existing two children, or public official status; however, only a limited number of studies contributed to these analyses. TCFI and FCI remained low in Eastern China after implementation of the three-child policy. Several demographic and socioeconomic factors were associated with TCFI, whereas evidence regarding factors associated with FCI remained limited and inconclusive. Given the substantial heterogeneity and limited evidence for FCI-related factors, these findings should be interpreted with caution.
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