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Infant's sex, birth control policy and postpartum well-being: a prospective cohort study in Shanghai, China
  1. Jing Hua1,
  2. Liping Zhu2,
  3. Wenchong Du3,
  4. Li Du2,
  5. Ting Luo4,
  6. Zhuochun Wu4
  1. 1Department of Shanghai First Maternity and Infant Hospital, The Women and Children's Health Care, Tongji University School of Medicine, Shanghai, China
  2. 2The Research Office of Shanghai Maternity and Child Health Care Center, Shanghai, China
  3. 3Psychology Division, Nottingham Trent University, Nottingham, UK
  4. 4Department of Public health School, Health Statistics and Social Medicine, Fudan University, Shanghai, China
  1. Co-correspondence to Professor Liping Zhu; shzhuliping{at} and Dr Jing Hua; szhuaj{at}


Objectives The majority of Chinese families were under either one-child or two-child birth control policy status from 2001 to 2015. We explore the association between an infant's sex and the mother's postpartum well-being, which may be moderated by birth control policy status in China.

Setting and participants We conducted a prospective cohort study in Shanghai City, one of the largest cities in China. A total number of 1730 childbearing women from eight obstetric hospitals across Shanghai were included in the study at baseline, with 1503 women completing the survey 7 days postpartum in 2013.

Measures The General Well-Being Schedule (GWBS) was used to assess maternal well-being at baseline and follow-up investigation in the study. The women's demographic, clinical characteristics, and well-being were measured at baseline. Maternal satisfaction and postpartum well-being were assessed in the follow-up survey.

Results Multivariable linear regression analyses showed that women who gave birth to male infants were positively associated with the total score of maternal well-being, when the participating hospitals, maternal well-being at baseline, sociodemographic characteristics, and maternal and infant health outcomes were added to the adjustments (β=1.462, p<0.05). The association disappeared when the two-child policy status was added to the adjustments (p>0.05). The results of a multiple logistic regression model showed that having a male infant was a risk factor of ‘severe distress’ (OR=1.607, p<0.05), which was moderated by the two-child policy status (p>0.05).

Conclusions Our results emphasise the importance of conducting interventions to increase maternal general well-being, especially for those with a female infant in a society such as China where preference is for a son, and enhance the necessity of sustainability of a newly relaxed two-child policy which allows more couples to have a second child in China.

  • Infant’s sex
  • Birth control policy
  • Postpartum well-being
  • China

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  • Contributors JH and LZ were responsible for the study design, analysis of the study and approval of the submitted and final version. LD, WD and TL contributed to the execution and analysis of the study. ZW contributed to revising the paper and approval of the final version.

  • Funding National Natural Science Foundation of China (81402687, 81673179), the Science and Technology Commission of Shanghai Municipality (15495810500, 14411970900), and the key discipline of Shanghai 3-year program of public health (15GWZK0401).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Ethics Committees of the Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine (#2013-09).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.