{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:53:04Z","timestamp":1791924784141,"version":"4.3.4"},"reference-count":33,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T00:00:00Z","timestamp":1566345600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To measure the association of China\u2019s universal two child policy, announced in October 2015, with changes in births and health related birth characteristics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>National, descriptive before-and-after comparative study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Every county in 28 of 31 provinces of mainland China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Births included in two national databases: 67\u2009786\u2009749 births from county level monthly aggregated data between January 2014 and December 2017; and 31\u2009786\u2009279 deliveries from individual level delivery information records between January 2015 and December 2017.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Monthly mean number of births and mean proportion of multiparous mothers and mothers aged 35 and over, preterm deliveries, and caesarean deliveries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 (\u22123.5 to \u22122.5) among nulliparous mothers from 39.6% to 36.6%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmj.l4680","type":"journal-article","created":{"date-parts":[[2019,8,22]],"date-time":"2019-08-22T03:55:25Z","timestamp":1566446125000},"page":"l4680","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":142,"title":["Association of China\u2019s universal two child policy with changes in births and birth related health factors: national, descriptive comparative study"],"prefix":"10.1136","author":[{"given":"Hong-tian","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Hellerstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqiu","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yali","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2126-1376","authenticated-orcid":false,"given":"Jie","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Blustein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3220-6084","authenticated-orcid":false,"given":"Jian-meng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,21]]},"reference":[{"key":"key20190823000400_ref1","first-page":"35","article-title":"Accumulated couples and extra births under the universal two-child policy","volume":"40","author":"Zhai","year":"2016","journal-title":"Renkou Yanjiu"},{"key":"key20190823000400_ref2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4457.2007.00161.x"},{"key":"key20190823000400_ref3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMhpr051833"},{"key":"key20190823000400_ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.16279"},{"key":"key20190823000400_ref5","doi-asserted-by":"publisher","DOI":"10.1080\/02664769100000021"},{"key":"key20190823000400_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.scib.2018.08.007"},{"key":"key20190823000400_ref7","doi-asserted-by":"publisher","DOI":"10.3917\/pope.1103.0519"},{"key":"key20190823000400_ref8","first-page":"133","article-title":"Fertility desire for the middle class groups after family planning policy adjustments: A cross-sectional survey conducted in Beijing, Shanghai, and Guangzhou","volume":"6","author":"Tian","year":"2017","journal-title":"Shehuixue Yanjiu"},{"key":"key20190823000400_ref9","first-page":"26","article-title":"Study on the influence of \u201cFull Two-Child\u201d Policy on incremental population and aging population","volume":"1","author":"Meng","year":"2016","journal-title":"Journal of Guangdong University of Finance and Economics"},{"key":"key20190823000400_ref10","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000158118.75532.51"},{"key":"key20190823000400_ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-010-1459-4"},{"key":"key20190823000400_ref12","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-018823"},{"key":"key20190823000400_ref13","doi-asserted-by":"publisher","DOI":"10.2147\/IJWH.S41410"},{"key":"key20190823000400_ref14","unstructured":"National Health and Family Planning Commission. 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The regulatory guidance of the State Council of China on solving the Hukou registration problem for people who do not have a Hukou. 2016. http:\/\/www.gov.cn\/zhengce\/content\/2016-01\/14\/content_10595.htm."},{"key":"key20190823000400_ref24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2011.01327.x"},{"key":"key20190823000400_ref25","first-page":"2781","article-title":"A 12-month prospective survey of perinatal outcome of liveborn neonates in Julu County, China","volume":"123","author":"Ma","year":"2010","journal-title":"Chin Med J (Engl)"},{"key":"key20190823000400_ref26","doi-asserted-by":"publisher","DOI":"10.3109\/14767058.2013.794208"},{"key":"key20190823000400_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(18)30451-0"},{"key":"key20190823000400_ref28","unstructured":"China Statistical Yearbook. 2017. http:\/\/www.stats.gov.cn\/tjsj\/ndsj\/2017\/indexeh.htm."},{"key":"key20190823000400_ref29","first-page":"2","article-title":"The actual and ideal fertility age of Chinese population: 1994-2012","volume":"22","author":"Zhang","year":"2016","journal-title":"Population & Development"},{"key":"key20190823000400_ref30","unstructured":"National Health and Family Planning Commission of the PRC. 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