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Determinants of second pregnancy among pregnant women: a hospital-based cross-sectional survey in China
  1. Xianglong Xu1,2,3,
  2. Hanxiao Zuo1,2,3,
  3. Zumin Shi4,
  4. Yunshuang Rao5,
  5. LianLian Wang6,7,8,
  6. Huan Zeng1,2,3,
  7. Lei Zhang9,10,11,12,
  8. Manoj Sharma13,14,
  9. Cesar Reis15,
  10. Yong Zhao1,2,3
  1. 1School of Public Health and Management, Chongqing Medical University, Chongqing, China
  2. 2Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China
  3. 3The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
  4. 4Faculty of Health Sciences, School of Medicine, The University of Adelaide, North Terrace Adelaide, South Australia, Australia
  5. 5School of Nursing, Chongqing Medical University, Chongqing, China
  6. 6The Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  7. 7Department of Reproduction Health and Infertility, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  8. 8Canada-China-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, Chongqing, China
  9. 9Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
  10. 10Faculty of Medicine, Central Clinical School, Nursing and Health Sciences, Monash University, Melbourne, Australia
  11. 11Faculty of Medicine, School of Public Health and Preventive Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
  12. 12Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
  13. 13Department of Behavioral and Environmental Health, Jackson State University, Jackson, UK
  14. 14Walden University, USA
  15. 15Department of Preventive Medicine, Loma Linda University Medical Center, Loma Linda, California, USA
  1. Correspondence to Dr Yong Zhao; zhaoyongzb{at}


Objectives This study aimed to explore determinants of second pregnancy and underlying reasons among pregnant Chinese women.

Design The study was a population-based cross-sectional survey.

Setting 16 hospitals in 5 provinces of Mainland China were included.

Participants A total of 2345 pregnant women aged 18 years or above were surveyed face to face by investigators between June and August 2015.

Main outcome measures The pregnancy statuses (first or second pregnancy) and reasons for entering second pregnancy.

Results A total of 1755 (74.8%) and 590 (25.2%) women in their respective first and second pregnancies were enrolled in this study. The most common self-reported reasons for entering second pregnancy among participants included the benefits to the first child (26.1%), love of children (25.8%), adoption of the 2-child policy (11.5%), concerns about losing the first child (7.5%) and suggestions from parents (7.5%). Pregnant women with low (prevalence ratio (PR) 1.96; 95% CI 1.62 to 2.36) and moderate education level (PR 1.97; 95% CI 1.65 to 2.36) were more likely to have a second pregnancy than their higher educated counterparts. Income was inversely associated with second pregnancy. However, unemployed participants (PR 0.79; 95% CI 0.66 to 0.95) were less likely to enter a second pregnancy than those employed. Women with moderate education were 3 times more likely to have a second child following the ‘2-child policy’ than the low education level subgroup.

Conclusions 1 in every 4 pregnant women is undergoing a second pregnancy. The benefits of the firstborn or the love of children were the key drivers of a second pregnancy. Low socioeconomic status was positively associated with a second pregnancy as well. The new 2-child policy will have an influence on China's demographics.


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  • Contributors All authors contributed to the overall conception and design of the study. XX contributed to the study design, data analysis, data interpretation and drafting of the manuscript. HaZ, YR, LW and YZ participated in the design of the study and helped draft the manuscript. MS, HuZ, LZ and CR contributed to the interpretation of study results and helped draft the manuscript. All authors read and approved the final manuscript.

  • Funding This project was supported by the Medjaden Academy and Research Foundation for Young Scientists (grant number MJR20150047). This study was also funded by the Summer Social Practice Project of School of Public Health and Management, Chongqing Medical University.

  • Competing interests None declared.

  • Ethics approval The study protocol was approved by the Ethics Committee of Chongqing Medical University (no. 2015008).

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

  • Data sharing statement No additional data are available.

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