Third Birth Intention of the Working Women with Two Existing Children in Hainan Island, China: The Impact of Fertility Costs and Utility

Abstract Background Few studies have explored the impact of fertility costs and utility on the third birth intention of Chinese women in the context of the “three-child policy.” Aim The present study aimed to acknowledge the status and impact of fertility costs and utility of the third birth intention of working women with two existing children in China. Methods This study conducted a cross-sectional survey in Hainan Island, China, from October 1st to November 1st, 2021, using an offline survey. Structured questionnaires were used to collect data such as fertility intentions, fertility costs and utility, and demographics and family characteristics. A multinomial logistic regression analysis determined the associations between childbearing intention and fertility costs and utility. Findings: Data was collected from 1067 working women with two existing children in Hainan Island, China. Among them, only 8.06% of participants reported having a third-birth intention. After adjustment for potential confounding factors, higher economic cost (odds ratio(OR) = 1.89) and lower succession utility (OR = 5.08) were significantly associated with the lack of intent to have a third child. Conclusion Working women with two existing children in Hainan Island had a low intention to give birth to a third child. It is necessary to transfer or share the economic costs of child-rearing for people of childbearing age at the national level, such as providing third-child subsidies, to increase the birth rates. Moreover, more emphasis should be placed on family values and responsibilities and a cultural environment conducive to reproduction.