Original Article| Volume 36, ISSUE 1, P65-71, February 2023

Fertility Intentions, Parenting Attitudes, and Fear of Childbirth among College Students in China: A Cross-Sectional Study

Published:August 03, 2022DOI:


      Study Objective

      This study aimed to investigate the current situation regarding fertility intentions, parenting attitudes, and fear of childbirth among college students in mainland China and the factors related to these variables.


      A cross-sectional study


      Colleges across China


      Five hundred and eighty-three college students attending regular institutions of higher education

      Main Outcome Measures

      Fertility intentions and fear of childbirth were measured using the Swedish Fertility Awareness Questionnaire and the Childbirth Fear Prior to Pregnancy scale.


      Only 38.8% of participants expressed their willingness to have children, and there was a significant difference between male and female students (P < .02). Males regarded having children as more important (P < .01), and females were more concerned about the negative effects of becoming parents, including difficulties in the labor market, having less freedom, and having less money. When deciding whether to have children, factors such as work, economics, and childcare were more important to females. Students who did not want children had higher levels of fear of childbirth than those who wanted children or were unsure (P < .02).


      The fertility intentions of college students were not optimistic. In addition to the 2-child Chinese fertility policy, interventions aimed at reducing the cost of raising children, eliminating gender inequality in the workplace, and normalizing childcare institutions might help alleviate conflict between work and childrearing.

      Key Words

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      1. The World Bank: Fertility rate, total (births per women), 2019. Available: Accessed June 1, 2021

        • Daniluk JC
        • Koert E,
        • Cheung A
        Childless women's knowledge of fertility and assisted human reproduction: identifying the gaps.
        Fertil Steril. 2012; 97: 420
        • Mahey R
        • Gupta M
        • Kandpal S
        • et al.
        Fertility awareness and knowledge among Indian women attending an infertility clinic: A cross-sectional study.
        BMC Womens Health. 2018; 18: 177
        • Voicu M,
        • Badoi D
        Fertility and the COVID-19 crisis: do gender roles really matter?.
        Eur Soc. 2021; 23: S199
        • Zeng Y,
        • Hesketh T
        The effects of China's universal two-child policy.
        Lancet. 2016; 388: 1930
        • Fang C
        Population dividend and economic growth in China, 1978-2018.
        China Economic J. 2018; 11: 243
        • Liu SL,
        • Hu AG
        Demographic change and economic growth: theory and evidence from China.
        Econ Model. 2013; 35: 71
        • Hashemzadeh M
        • Shariati M
        • Mohammad Nazari A
        • et al.
        Childbearing intention and its associated factors: a systematic review.
        Nurs Open. 2021; 8: 2354
        • Chen MN,
        • Yip PSF
        The discrepancy between ideal and actual parity in Hong Kong: fertility desire, intention, and behavior.
        Popul Res Policy Rev. 2017; 36: 583
        • Dewau R
        • Mekonnen FA,
        • Seretew WS
        Time to first birth and its predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model.
        BMC Womens Health. 2021; 21
        • Chan CH
        • Chan TH
        • Peterson BD
        • et al.
        Intentions and attitudes towards parenthood and fertility awareness among Chinese university students in Hong Kong: a comparison with Western samples.
        Hum Reprod. 2015; 30: 364
        • Zhou Y
        • Luo Y
        • Wang T
        • et al.
        College students responding to the Chinese version of Cardiff fertility knowledge scale show deficiencies in their awareness: a cross-sectional survey in Hunan, China.
        BMC Public Health. 2020; 20: 810
        • Nilsson C
        • Hessman E
        • Sjoblom H
        • et al.
        Definitions, measurements and prevalence of fear of childbirth: a systematic review.
        BMC Pregnancy Childbirth. 2018; 18: 28
        • Bergstrom M
        • Rudman A
        • Waldenstrom U
        • et al.
        Fear of childbirth in expectant fathers, subsequent childbirth experience and impact of antenatal education: subanalysis of results from a randomized controlled trial.
        Acta Obstet Gynecol Scand. 2013; 92: 967
        • Zigic Antic L
        • Nakic Rados S
        • Jokic-Begic N
        Are non-pregnant women afraid of childbirth? Prevalence and predictors of fear of childbirth in students.
        J Psychosom Obstet Gynaecol. 2019; 40: 226
        • Stoll K
        • Hall W
        • Janssen P
        • et al.
        Why are young Canadians afraid of birth? A survey study of childbirth fear and birth preferences among Canadian university students.
        Midwifery. 2014; 30: 220
        • Lampic C
        • Svanberg AS
        • Karlstrom P
        • et al.
        Fertility awareness, intentions concerning childbearing, and attitudes towards parenthood among female and male academics.
        Hum Reprod. 2006; 21: 558
        • Stoll K
        • Hauck Y
        • Downe S
        • et al.
        Cross-cultural development and psychometric evaluation of a measure to assess fear of childbirth prior to pregnancy.
        Sex Reprod Healthc. 2016; 8: 49
        • Meczekalski B
        • Czyzyk A
        • Kunicki M
        • et al.
        Fertility in women of late reproductive age: the role of serum anti-Mullerian hormone (AMH) levels in its assessment.
        J Endocrinol Invest. 2016; 39: 1259
        • Jansen NA
        • Saint Onge JM
        An internet forum analysis of stigma power perceptions among women seeking fertility treatment in the United States.
        Soc Sci Med. 2015; 147: 184
        • Zhang F
        • Lv Y
        • Wang Y
        • et al.
        The social stigma of infertile women in Zhejiang Province, China: a questionnaire-based study.
        BMC Womens Health. 2021; 21: 97
        • Dowling M
        • Brown G
        Globalization and international adoption from China.
        Child Fam Soc Work. 2009; 14: 352
        • Yang B
        • Zhang JC
        • Qi YX
        • et al.
        Assessment on occurrences of depression and anxiety and associated risk factors in the infertile Chinese men.
        Am J Mens Health. 2017; 11: 767
        • Mogilevkina I
        • Stern J
        • Melnik D
        • et al.
        Ukrainian medical students' attitudes to parenthood and knowledge of fertility.
        Eur J Contracept Reprod Health Care. 2016; 21: 189
        • Erfani A
        • Jahanbakhsh R
        Do spousal intimate relationships affect fertility intentions and preferences?.
        J Fam Issues. 2021; 1
        • Liu Y
        • Fu R
        • Roberto KA
        • et al.
        Depressive symptoms among adult children caregivers in China: Moderating effects of working status and gender.
        Aging Ment Health. 2019; 23: 1391
        • Horwood C
        • Surie A
        • Haskins L
        • et al.
        Attitudes and perceptions about breastfeeding among female and male informal workers in India and South Africa.
        BMC Public Health. 2020; 20: 875
        • Zhou Y
        The dual demands: gender equity and fertility intentions after the one-child policy.
        J Contemp China. 2018; 28: 367
        • Moran E
        • Bradshaw C
        • Tuohy T
        • et al.
        The paternal experience of fear of childbirth: an integrative review.
        Int J Environ Res Public Health. 2021; 18: 1231
      2. Hendi AS: Globalization and contemporary fertility convergence.
        Soc Forces. 2017; 96: 215
        • Wei J
        • Xue J
        • Wang D
        Socioeconomic determinants of rural women's desired fertility: a survey in rural Shaanxi, China.
        PLoS One. 2018; 13e0202968
        • Gotmark F
        • Andersson M
        Human fertility in relation to education, economy, religion, contraception, and family planning programs.
        BMC Public Health. 2020; 20: 265
        • Peterson BD
        • Pirritano M
        • Tucker L
        • et al.
        Fertility awareness and parenting attitudes among American male and female undergraduate university students.
        Hum Reprod. 2012; 27: 1375
        • Daniluk JC
        • Koert E
        Fertility awareness online: the efficacy of a fertility education website in increasing knowledge and changing fertility beliefs.
        Hum Reprod. 2015; 30: 353
        • Chen H
        • Wang X
        • Li Z
        • et al.
        The impact of neighborhood environment on women's willingness to have a second child in China.
        Inquiry. 2019; 5646958019833232
      3. The State Council the People's Republic of China: Guidelines of the General Office of the State Council on promoting the development of care services for infants and children under 3 years of age 2019. Available: Accessed March 25, 2022,

        • Li YR
        The effects of formal and informal child care on the mother's labor supply-evidence from urban China.
        China Econ Rev. 2017; 44: 227
        • Shen Y
        • Jiang L
        Reproductive choices of highly educated employed women with two children under the universal two-child policy.
        J Fam Issues. 2019; 41: 611
        • Yao H
        • Chan CHY
        • Chan CLW
        Childbearing importance: a qualitative study of women with infertility in China.
        Res Nurs Health. 2018; 41: 69
      4. China, MoEotPsRo: 2020 Education Statistics 2021. Available: Accessed March 25, 2022

        • Place JM
        • Peterson BD
        • Horton B
        • et al.
        Fertility awareness and parenting intentions among Mexican undergraduate and graduate university students.
        Hum Fertil (Camb). 2020; 1
        • Luo H
        • Mao ZY
        From fertility intention to fertility behavior.
        Asian Popul Stud. 2014; 10: 195
        • Stoll KH
        • Hauck YL
        • Downe S
        • et al.
        Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education.
        Reprod Health. 2017; 14: 116