Determinants of second pregnancy among pregnant women: a hospital-based cross-sectional survey in China

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.