How two-child policy affects cesarean section in women with advanced maternal age (AMA): using the Robson classification system.

OBJECTIVES: To study the possible associations between advanced maternal age and cesarean section(CS) under the two child policy. METHODS: This study used a cohort study from Dongguan People's Hospital in Guangdong Province, China from 2017 to 2020. The cohort was restricted to women aged ≥ 20 who give birth to babies with a gestational age of > 28 weeks and a weight of > 1000 g. Divide the advanced maternal age (AMA) pregnant women into two age groups: 35-39 years old and 40 years old or older age. We analyzed CS rate and CS contribution using the modified Robson classification system. Frequency of cesarean was determined for each group and compared by using χ2 and prevalence ratio. RESULTS: Overall, 47654 women were included, of which 7924 (16.63%) were between the ages of 35 and 39, and 1529 (3.21%) were aged 40 or older. The total CS rate is 40.64%, with 36.10% for mothers aged 20 to 34, 57.90% for women aged 35 to 40, and 64.75% for women aged 40 or older age. In the AMA groups (n = 9453), Robson group 2' was the most common, followed by groups 5 and 10. Women at 40 years or older age were 3 times more likely to undergo a cesarean delivery in Robson group 1', and 1.76 times more likely in group 10. The CS rate in group 2' were statistically significantly higher in the very AMA group. CONCLUSIONS: The CS rates increased noticeably with maternal age under the two child policy. Based on the modified Robson classification system, AMA women should pay more attention to primiparous women with single pregnancy, uterine scars, and premature birth in multiple pregnancies.

Socio-demographic characteristics and outcomes of pregnant women who delivered prior to and after the termination of the one-child policy in China: a comparative study.

BACKGROUND: The new Chinese fertility policy has recently received widespread public attention. However, there are few studies available on the comprehensive epidemiology of maternal and infant health with respect to the characteristic changes of childbearing women. In the study, we compared the maternal characteristics and pregnancy outcomes at different time points according to policy adjustments, accessed the possible relationship among these factors, and evaluated the impacts of these policies for medical and policy assistance. METHODS: This was a retrospective study. Data were collected from three representative hospitals in Zhejiang Province using stratified random sampling. The annual number of births, and maternal and child healthcare levels were the determining factors of sampling. Women who gave birth in November of 2012, 2014, and 2016 were recruited in accordance with the time of the change in the fertility policy, and we explored the differences in maternal socio-demographic characteristics, delivery mode and pregnancy outcomes. RESULTS: A total of 11,718 women were recruited, including 3480, 4044, and 4194 in November of 2012, 2014, and 2016, respectively. The proportions of multiparous women, women who aged ≥35 years, who received higher education, who had previous cesarean sections (CS), and who delivered in a high level hospital increased over time. In 2016, multipara accounted for 49.12, 14.47% were aged ≥35 years, nearly half of women had previous CS and delivered in a provincial hospital, 41.73% gave birth by CS, and 31.62% suffered pregnancy complications. The results of multiple logistic regression mode showed CS risk decreased significantly in 2014 (ORadj = 0.62; 95% CI, 0.55-0.67) relative to 2012, and risks of pregnancy complications (ORadj = 2.30; 95% CI, 1.86-2.83) and multiple births (ORadj = 3.25; 95% CI, 2.19-4.83) only increased in 2016 compared to 2012. CONCLUSIONS: Some pregnancy outcomes increased as several key characteristics of childbearing women changed after China ended its "one-child" policy. This suggests that policy providers and medical staff need to strengthen healthcare in a consistent fashion regarding changes in birth policy.

Reproductive health status and related knowledge among women aged 20-39 years in rural China: a cross-sectional study.

BACKGROUND: Reproductive health is the core science of human life and is critical to the healthy and sustainable development of human society. Since 1980, China has enforced a "one child" policy. With the implementation of the Universal Two-Child Policy in 2016, every couple is allowed to have two children instead of one, which will lead to more pregnancies, births, and advanced maternal age. Thus, women aged 20-39 years, at the peak of sexual activity and fertility, will face more reproductive health problems related to pregnancies and births. This study aimed to investigate the current reproductive health status, knowledge, and factors associated with reproductive health knowledge among women aged 20-39 years in rural China. METHODS: A cross-sectional study was conducted in five villages of five cities in China. The data were collected using pre-tested and structured questionnaires through face-to-face interviews. The data were entered into Epidata version 3.0, and analyzed using SPSS version 18.0. A descriptive summary of the data and logistic regression were used to identify associated factors. RESULTS: One-third of the participants reported that they had suffered from gynecopathy, and 38.89% of participants with gynecopathy-related discomfort did not seek medical treatment. Condoms and intrauterine devices were the main contraceptive measures used, and 28.70% of women had a history of induced abortion. Over half of the respondents (53.00%) were classified as having a low reproductive health knowledge score. Factors associated with lower knowledge levels were lower education, no history of gynecopathy, and lack of acquiring knowledge from medical staff, WeChat/micro-blog, or the internet. CONCLUSION: A poor reproductive health situation and low level of health knowledge were found among women aged 20-39 years in rural China. More specific interventions promoting reproductive health and targeting rural women aged 20-39 years are needed.

Individual differences in relative fertility costs and fertility benefits and their effects on fertility desire for a second child in China: a latent profile analysis.

BACKGROUND: Fertility desire for a second child has been a lively topic since the implementation of the two-child policy in China. Chinese researchers have explored various factors influencing the fertility desire for a second child. However, there have not been studies on the individual differences in the relative fertility costs and fertility benefits and their effects on fertility desire for a second child. METHODS: A total of 396 participants rated four kinds of relative fertility costs, four kinds of fertility benefits and their fertility desire for a second child. Latent profile analysis (LPA) was used to explore the individual differences in the relative fertility costs and fertility benefits and their effects on fertility desire for a second child. RESULTS: Stepwise regression analysis showed that parenting joy, health risks, mutual care among siblings, the flourishing of family, and time pressure and opportunity cost significantly predicted the fertility desire for the second child. According to the latent profile analysis, the participants were classified into four classes. Participants in the lowest-cost/lowest-benefit and high-cost/medium-benefit classes had low fertility desire for a second child, while those in the low-cost/high-benefit and highest-cost/highest-benefit classes had high fertility desire. CONCLUSION: Fertility benefits have a stronger effect on the fertility desire for a second child than relative fertility costs. Fertility benefits should be paid more attention to than relative fertility costs.

Exploring women's decisions about childbearing after the lifting of the one-child policy.

In 2016, China officially ended the 'one-child' policy permitting all couples to have two children for the first time since 1979. While the policy was relaxed due to demographic concerns, it simultaneously provided many women with a new reproductive opportunity. The goal of this study was to qualitatively understand the childbearing decision process in the new era of the two-child policy. We conducted in-depth, semi-structured interviews with 45 postpartum women at two hospitals in Zhejiang Province, China. The interviews explored women's views on the two-child policy and reproductive decisions and how they decided to have their first or second child. Most women approved of the lifting of the one-child policy; however, many were hesitant or uncertain about their own decisions to have second children. Many felt pressured to have two children for the good of, or as an obligation to, the family. However, they also felt that caring for two children was burdensome, and that they would have to sacrifice a lot in terms of freedom, energy and money. Their responses to the new reproductive opportunity highlight the complexity of childbearing decision-making in modern Chinese society, against a background of persisting traditional values.

Are single children more likely to be overweight or obese than those with siblings? The influence of China's one-child policy on childhood obesity.

China's one-child policy (1979-2015) has affected Chinese parenting practices and children's health behaviors and also may have contributed to increased childhood obesity. However, very limited research has investigated the association between one-child policy and childhood obesity. We examined characteristics of single-child families and the influence of one-child policy (indicated by single-child status) on children's weight status and related health behaviors. Data from children aged 6-18years old in the 2011 (n=1580) and 2000 (n=2317) China Health and Nutrition Survey were cross-sectionally analyzed with multilevel models. From 2000 to 2011, the rates about doubled for being a single-child (30.1% to 57.0%) and being overweight or obese (OWB, 6.6% to 16.5%) along with urbanization (27.5% to 37.1%). Single-child families had higher levels of parental education, household income and urban residence than families with ≥ two children (p<0.05). Compared to the children with siblings, single children were more likely to be OWB; the association became stronger over time (OR=4.5 (1.7-12.4) in 2011 and 1.7 (1.0-2.8) in 2000). Also, single children had less recreational screen time, but similar physical activity levels; however single urban children were more likely to have excess total energy intake (OR=5.70 (1.58-20.60)) than those with siblings. Being single-child is about four times more likely to be overweight/obesity than those having siblings, and the association became stronger over time in China. China's one-child policy might have contributed to its rising childhood obesity rates. Obesity intervention programs may need to account for the influence of the one-child policy in China.

A mapping of the positions of adults in Toulouse, France, regarding induced abortion.

BACKGROUND: Are people's views on abortion as polarised as is suggested by the 'marches for life' that regularly take place in Paris and other capitals? Objective To map French people's positions regarding the acceptability of induced abortion. METHODS: One hundred and fifty-nine participants were presented with stories composed according to a three within-subject design: Reason for abortion (e.g., the woman's life is endangered) × Gestational age × Woman's age. They assessed the extent to which abortion would be, in each case, an acceptable medical/surgical procedure. RESULTS: Five qualitatively different positions were identified: (i) always acceptable, irrespective of circumstances (31% of the sample), (ii) strictly depends on the reason for abortion (27%), (iii) legalist (23%), (iv) depends on the reason and on the gestational age (18%), and (v) always unacceptable (1%). CONCLUSIONS: Only one-fifth of the participants agreed with the part of the French law that permits abortion on request when gestational age does not exceed ten weeks. The others disagreed either because they thought that abortion on demand should never be permitted or because they thought that the age limit should be extended. This divide in people's opinions guarantees that the debate over induced abortions will continue.

Mandatory single embryo transfer policy dramatically decreases multiple pregnancy rates.

AIM: The aim of this study is to determine the effect of a mandatory single embryo transfer (SET) policy on pregnancy rates and multiple pregnancy rates in intracytoplasmic sperm injection (ICSI) cycles. METHODS: One hundred and twenty-eight patients (154 cycles) underwent ICSI before the Turkish Ministry of Health's legislation, 55 patients (69 cycles) underwent ICSI after the legislation (day-3 embryo transfers only) and 35 patients (39 cycles) who underwent ICSI after the legislation (day-5 embryo transfers only). RESULTS: Groups were comparable regarding the women's mean age and body mass index. The number of embryos transferred (2.7 ± 0.5 vs 1.0 ± 0.0 vs 1.0 ± 0.0) was significantly higher in group I, compared to group II and group III. Clinical pregnancy per embryo transfer (40.8% vs 15.1% vs 36.1%) and live birth rate (37.7% vs 13.2% vs 30.6%) were significantly lower in group II when compared to group I and group III. Multiple pregnancy rates (39.6% vs 0.0%, vs 0.0%) were significantly higher in group I when compared to group II and III. Implantation rates were significantly higher in group III when compared to group I and group II. Miscarriage rates were comparable among the groups. CONCLUSION: The mandatory SET policy caused a dramatic decrease of multiple pregnancy rates. Mandatory SET with only day-3 embryo transfers decreased the pregnancy rates but this detrimental effect was not seen in cycles with day-5 embryo transfers.

China's one-child policy, a policy without a future. Pitfalls of the "common good" argument and the authoritarian model.

The Chinese Communist Party government has been forcefully promoting its jihua shengyu (planned fertility) program, known as the "one-child policy," for more than three decades. A distinctive authoritarian model of population governance has been developed. A pertinent question to be asked is whether China's one-child policy and the authoritarian model of population governance have a future. The answer must be no; they do not. Although there are many demographic, economic, and social rationales for terminating the one-child policy, the most fundamental reason for opposing its continuation is drawn from ethics. The key ethical rationale offered for the policy is that it promotes the common social good, not only for China and the Chinese people but for the whole human family. The major irony associated with this apparently convincing justification is that, although designed to improve living standards and help relieve poverty and underdevelopment, the one-child policy and the application of the authoritarian model have instead caused massive suffering to Chinese people, especially women, and made them victims of state violence. A lesson from China--one learned at the cost of individual and social suffering on an enormous scale--is that an essential prerequisite for the pursuit of the common good is the creation of adequate constraints on state power.

[Reproductive health of women. Family planning and "reproductive rights" in Germany]. / Reproduktive Gesundheit. Eine Bilanz der Familienplanung in Deutschland.

The WHO (World Health Organization) definition of reproductive health establishes reproductive rights for women and men. This includes the capability to reproduce and the freedom to decide, if, when, and how often to do so. In this article the implementation of these rights in Germany is evaluated, focusing on selected aspects of family planning. Findings from empirical studies, surveys, and official registers on fertility intentions, on births, on contraception, and on abortion are compiled. Moreover, the influence of social aspects on reproductive health (education, migration background) is discussed. Records show high standards regarding information and access to contraceptives; however, more action and research are needed in three regards. First, men and women have fewer children than they would like to have, and the desire to have (more) children is deferred systematically. Second, the number and rate of abortions should be reduced. And third, more attention should be paid to social determinants that influence the access to reproductive health. Furthermore, the special needs of migrants should be taken into account.

Nigerian lawyers and reproductive health rights: a survey of knowledge, practices and opinions on law reforms among the bar and bench in north eastern Nigeria.

The objective of this study was to determine the knowledge and attitudes of practicing Nigerian lawyers towards issues relating to reproductive health and reproductive rights, and their opinions about abortion law reform. It was a population- based study which consisted of interviews with practicing lawyers in north-east Nigeria. The results showed poor knowledge of issues related to reproductive health and reproductive rights among the lawyers. However, the majority (56.9%) disagreed that a woman can practice family planning without the consent of her husband. The prevalence of contraceptive use among the lawyers was low and attitude to abortion law not satisfactory. Only few lawyers (22.4%) supported safe abortion in cases of failed contraception. We conclude that reproductive health advocates must target legal professionals with a view to educating them on issues relating to sexual and reproductive health and rights. Lawyers in Nigeria should undergo capacity building in reproductive health laws and be encouraged to specialize in reproductive rights protection as obtainable in other developed countries.

[An analysis of the first law on contraception in Argentina. The Responsible Procreation Programme in the province of La Pampa]. / Un análisis de la primera ley sobre anticoncepción en Argentina. El Programa de Procreación Responsable en la provincia de La Pampa.

The passage of a Law requires previous negotiation processes that consider the background, arguments, support and the appropriate terminology for approaching the issue. The legal domain is a discursive field in which a dual struggle develops: to establish designations and to introduce that which the law establishes into everyday practice. Hence, conflictive processes are unleashed in which social agents are confronted by political parties, by institutions and by their own political and subjective identities. This article analyses the development of the "1363 Law", which was passed in November 1991 in the legislature of La Pampa province (Argentina). This Law created a provincial programme for responsible procreation, the first provincial legislation on contraception to be established. Although reproduction also involves males, special account is taken of speeches referring to females, given that the culture superimposes maternity on the female identity and references are therefore weighted towards the condition of women. We use the particularity of this case and its analytical potential in order to understand others, using as empirical material the parliamentary debate and interviews with the author of the Law and with key informants. We address the following questions: What was the national and provincial context in which the Law on responsible procreation was framed? What were the strategies adopted to achieve it? How was contraception articulated within the Peronist worldview of women? What meanings did the term "responsible procreation" bring into play? Finally, we present a brief assessment of the law's application.

Women, microcredit and family planning practices: a case study from rural Ghana.

This paper examines the influence of informal banking club participation on family planning practices in rural Ghana. Research from Asia suggests that family planning practices are improved by club participation. This study examines this thesis in an African context, using rural Ghana as a case study. A sample of 204 women (19 years and older) was drawn from Abokobi village, Ghana. Multivariate analyses of direct, mediating and moderating effects of women's demographic background characteristics, membership status and length, and women's empowerment status as predictors of family planning practices are assessed. Findings suggest that club membership and membership length is not associated with family planning practices; however, age, education level, number of children and empowerment status are.

An investigation of women's attitudes towards fertility and China's family planning policy.

Reducing China's population has formerly been considered a good thing because of the perceived environmental and social risks of overpopulation, but it has recently become apparent that the resulting population decline may create problems that will become increasingly serious in the future. The results of a survey of 4600 women in nineteen Chinese provinces in 2005 indicated that young age, high income, high education level, urban location and good employment all decreased a woman's willingness to bear children. The risks created by declining fertility in these groups have been intensified by China's 'one child' family planning policy. However, as a result of current trends and China's policies, the country's population will continue to age, leading to social problems and difficulties for sustainable development both in China and around the world. Therefore, China's policy-makers must begin planning to adjust their policy by encouraging women to give birth to more than one child.