China’s three-child policy was implemented in May 2021 to stimulate a rise in fertility levels. However, few previous studies have explored fertility intentions to have a third child and have only focused on childless or one-child populations, resulting in a gap in findings between fertility intention and fertility behavior. Thus, we conducted a nationwide cross-sectional study on 1308 participants with two children. Results showed that only 9.6% of participants reported planning to have a third child and 80.2% of the population had heard of the policy but had no idea of the detailed contents. Participants with two daughters (OR = 3.722, 95% CI = 2.304–6.013) were willing to have one more child. Instrumental values (OR = 1.184, 95% CI = 1.108–1.265) and policy support (OR = 1.190, 95% CI = 1.124–1.259) were the facilitators. Perceived risk (OR = 0.883, 95% CI = 0.839–0.930) and higher educational level (OR = 0.693, 95% CI = 0.533–0.900) were the leading barriers to having one more child. Therefore, the government should deepen parents’ understanding of the “three-child policy” and devise ways of reducing the negative impacts of having a third child to boost the intention to have more children. Our proposed approach can also be used to better understand the reasons for low fertility rates in other countries.

Background A three-child policy was implemented in China to stimulate a rise in fertility levels and coincided with the COVID-19 pandemic. Data suggested that COVID-19 has a negative impact on fertility intention. Aim To describe married couples’ changes in intention to have a third child during the COVID-19 pandemic and determine factors associated with altered intentions. Methods An online survey was conducted in October 2021, including sociodemographic characteristics, change of intention to have a third child after the COVID-19 pandemic outbreak, reasons for increased or decreased intention, and the Fertility Intention Scale (FIS). Bivariate and multivariable logistic regression were used to test the potential factors associated with changes in intention. Results A total of 1308 participants provided responses. Following the COVID-19 outbreak, 35.8% of participants decreased their third-child intention, while 2.8% of participants increased their third-child intention. Males (aOR 1.90, 95% CI 1.42 to 2.54), youngsters (aOR 1.77, 95% CI 1.08 to 2.93) and those living in Estern China (aOR 2.12, 95% CI 1.13 to 3.98) were more likely to decrease their third-child intention. Perceived risk (aOR 1.07, 95% CI 1.03 to 1.10) and policy support (aOR 1.06, 95% CI 1.03 to 1.09) as measured on the FIS decreased couples’ intention to have a third child. Social support (aOR 0.94, 95% CI 0.91 to 0.98) as measured on the scale protected participants from decreased intention. Conclusions During severe public health emergencies, strong prevention and control policies, together with enhancing support from partners and healthcare professionals for women, are necessary to improve intentions to give birth.

Weight stigma is linked to adverse effects, but whether it directly heightens the risk of disordered eating behaviors or psychological factors mediate this connection among postpartum women is uncertain. To investigate the relationship between perceived weight stigma and disordered eating behaviors (restrained eating, emotional eating, and external eating) and identify the mediating role of weight bias internalization and postpartum depression (PPD). This cross-sectional study involved 507 postpartum women. Data were collected anonymously using self-reported questionnaires, including the Perceived Weight Stigma Questionnaire, Weight Bias Internalization Scale, Edinburgh Postpartum Depression Scale, and Dutch Eating Behavior Questionnaire. Data were analyzed using descriptive statistics, Pearson's correlation analysis, hierarchical linear regression, and mediation analysis. The results showed that the relationship between perceived weight stigma and disordered eating behaviors was fully mediated by weight bias internalization and PPD. Specifically, perceived weight stigma was associated with greater weight bias internalization, which was associated with greater PPD, and greater PPD was associated with greater disordered eating behaviors. This may be the first study to propose a chain mediation model exploring the roles of weight bias internalization and PPD in the relationship between perceived weight stigma and disordered eating behaviors among postpartum women. The findings enhance the understanding of the psychological impacts of perinatal weight stigma and underscore the importance of addressing weight stigma in postpartum care. Comprehensive interventions should be developed to enhance postpartum health and reduce the risk of disordered eating behaviors.

Improving pregnant women's birth preparedness to influence their choice of institutional birth is crucial for reducing pregnancy-related mortality in Tanzania. Attending antenatal care (ANC) may benefit birth preparedness, as women could learn how to prepare better for giving birth during the ANC. However, the epidemiological data is limited in Tanzania. This study aimed to investigate the association between ANC utilization and birth preparedness among Tanzanian pregnant women. We performed a cross-sectional analysis using baseline data of 656 pregnant women who participated in an educational app intervention study from November 2021 to February 2022 in Dar es Salaam, Tanzania. High utilization of ANC was defined as ANC visits ≥ 4 and initiating ANC in the first trimester. Birth preparedness was evaluated using the 24-item Birth Preparedness Questionnaire, with a pre-defined cut-off point of the top 20 percentile to indicate a high level of birth preparedness. We used multivariable logistic regression models to examine the association between ANC utilization and birth preparedness. The mean (SD) age of participants was 27 (5) years old. The proportion of high utilization of ANC was 66.5 %, and the median (IQR) birth preparedness total score was 68 (68-70) points. Compared with women who had low ANC utilization, those who had high ANC utilization were significantly associated with an increased likelihood of a high level of birth preparedness (unadjusted OR=1.70, 95 % CI = 1.20 - 2.40). This association remained statistically significant after adjustment for potential covariates (adjusted OR=1.76, 95 % CI= 1.23 - 2.52). Subgroup analysis revealed that the association between ANC utilization and birth preparedness didn't vary by parity. High utilization of ANC was associated with increased birth preparedness, independent of parity, suggesting the importance of addressing barriers to accessing ANC and promoting early and active ANC attendance for planned institutional birth with skilled birth attendants (SBAs).