TY - JOUR
T1 - Association of China's universal two child policy with changes in births and birth related health factors
T2 - National, descriptive comparative study
AU - Li, Hong Tian
AU - Xue, Ming
AU - Hellerstein, Susan
AU - Cai, Yue
AU - Gao, Yanqiu
AU - Zhang, Yali
AU - Qiao, Jie
AU - Blustein, Jan
AU - Liu, Jian Meng
N1 - Funding Information:
and National Natural Science Foundation of China (81571517, 81701538). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report, and did not participate in the decision to submit the manuscript for publication. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the National Key Research and Development Program of China, National Health Commission of China, and National Natural Science Foundation of China for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Ethical approval: This study was deemed exempt from the Peking University Health Science Centre’s institutional review board because it used previously collected data containing no personally identifiable information. Data sharing: No additional data available. The corresponding authors affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and, if relevant, registered) have been explained. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Funding Information:
1Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Centre, Beijing 100191, China 2Office for National Maternal and Child Health Statistics of China, School of Public Health, Peking University Health Science Centre, Beijing, China 3Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China 4Centre for Health Statistics and Information, National Health Commission of China, Beijing, China 5Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA 6Department of Maternal and Child Health, School of Public Health, Peking University Health Science Centre, Beijing, China 7Department of Obstetrics and Gynecology, Centre for Reproductive Medicine, Peking University Third Hospital, Beijing 100191, China 8Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China 9Reproductive Health Research Centre, Peking University Health Science Centre, Beijing, China 10Robert F Wagner Graduate School of Public Service, New York University, New York, NY, USA 11Department of Population Health, School of Medicine, New York University, New York, NY, USA We thank the thousands of health workers who contributed to the collection of the two datasets and the tens of millions of people who supplied the data. Contributors: HL, MX, SH, JQ, JB, and JL contributed to the conception and design of the study. JQ, JB, and JL provided overall guidance. HL, MX, YC, YG, and YZ contributed to data collection and cleaning. HL and MX did the analysis. HL, MX, SH, JQ, JB, and JL prepared the first draft. All authors reviewed the whole draft and approved the final manuscript. HL and MX are joint first authors. JQ and JL are joint corresponding authors. JQ and JL are the guarantors. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Funding: This study was supported by grants from the National Key Research and Development Program of China (2016YFC1000401, 2016YFC1000406-1), National Health Commission of China,
Publisher Copyright:
© Published by the BMJ Publishing Group Limited.
PY - 2019
Y1 - 2019
N2 - 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.
AB - 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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U2 - 10.1136/bmj.l4680
DO - 10.1136/bmj.l4680
M3 - Article
C2 - 31434652
AN - SCOPUS:85071277482
SN - 0959-8146
VL - 366
JO - The BMJ
JF - The BMJ
M1 - l4680
ER -