Association of China's universal two child policy with changes in births and birth related health factors: national, descriptive comparative study

被引:120
作者
Li, Hong-tian [1 ,2 ,3 ]
Xue, Ming [4 ]
Hellerstein, Susan [5 ]
Cai, Yue [4 ]
Gao, Yanqiu [2 ,6 ]
Zhang, Yali [1 ,2 ,3 ]
Qiao, Jie [7 ,8 ,9 ]
Blustein, Jan [10 ,11 ]
Liu, Jian-meng [1 ,2 ,3 ,9 ]
机构
[1] Peking Univ, Hlth Sci Ctr, Inst Reprod & Child Hlth, Natl Hlth Commiss,Key Lab Reprod Hlth, Beijing 100191, Peoples R China
[2] Peking Univ, Hlth Sci Ctr, Sch Publ Hlth, Off Natl Maternal & Child Hlth Stat China, Beijing, Peoples R China
[3] Peking Univ, Hlth Sci Ctr, Dept Epidemiol & Biostat, Sch Publ Hlth, Beijing, Peoples R China
[4] Natl Hlth Commiss China, Ctr Hlth Stat & Informat, Beijing, Peoples R China
[5] Harvard Med Sch, Dept Obstet & Gynecol, Brigham & Womens Hosp, Boston, MA 02115 USA
[6] Peking Univ, Sch Publ Hlth, Dept Maternal & Child Hlth, Hlth Sci Ctr, Beijing, Peoples R China
[7] Peking Univ, Hosp 3, Dept Obstet & Gynecol, Ctr Reprod Med, Beijing 100191, Peoples R China
[8] Minist Educ, Key Lab Assisted Reprod, Beijing, Peoples R China
[9] Peking Univ, Hlth Sci Ctr, Reprod Hlth Res Ctr, Beijing, Peoples R China
[10] NYU, Robert F Wagner Grad Sch Publ Serv, New York, NY 10003 USA
[11] NYU, Sch Med, Dept Populat Hlth, New York, NY USA
来源
BMJ-BRITISH MEDICAL JOURNAL | 2019年 / 366卷
基金
中国国家自然科学基金;
关键词
END;
D O I
10.1136/bmj.l4680
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE To measure the association of China's universal two child policy, announced in October 2015, with changes in births and health related birth characteristics. DESIGN National, descriptive before-and-after comparative study. SETTING Every county in 28 of 31 provinces of mainland China. PARTICIPANTS Births included in two national databases: 67 786 749 births from county level monthly aggregated data between January 2014 and December 2017; and 31 786 279 deliveries from individual level delivery information records between January 2015 and December 2017. MAIN OUTCOME MEASURES Monthly mean number of births and mean proportion of multiparous mothers and mothers aged 35 and over, preterm deliveries, and caesarean deliveries. RESULTS The study had two phases: the baseline period (up to and including June 2016, nine months after the policy announcement) and the effective period (from July 2016 to December 2017). The estimated number of additional births attributable to the new policy between July 2016 and December 2017 was 5.40 million (95% confidence interval 4.34 to 6.46). The monthly mean percentage of multiparous mothers and mothers aged 35 and over increased by 9.1 percentage points (95% confidence interval 6.4 to 11.7) and 5.8 percentage points (5.2 to 6.4), respectively. This increase in older mothers, however, was not associated with a concurrent increase in the overall rate of preterm birth. The monthly mean caesarean delivery rate among multiparous mothers increased by 1.2 percentage points (0.8 to 1.6) from 39.7% to 40.9%, and decreased by 3.0 percentage points (-3.5 to-2.5) among nulliparous mothers from 39.6% to 36.6%. CONCLUSIONS Since its announcement in October 2015, the universal two child policy has been associated with a rise in births in China and with changes in health related birth characteristics: women giving birth have been more likely to be multiparous, and more likely to be aged 35 and over. No evidence of concurrent worsening outcomes (that is, premature births) was seen.
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