Author(s)

Ying Zhou ¹

Affiliation(s)

¹ School of Public Finance & Taxation, Guangdong University of Finance & Economics, Guangzhou, China

Corresponding Author

Ying Zhou

ABSTRACT

Over the past decade, China has experienced rapid and large-scale fertility policy transitions, shifting from a strict one-child policy to a comprehensive three-child policy, which provides a unique natural experiment to explore how policy-driven fertility pattern changes affect women's physical and mental health. To address the absence of an integrated analytical framework, we developed a multidimensional framework synthesizing life course epidemiology, allostatic load theory, resource allocation theory, and cumulative health disadvantage theory, combined with systematic literature review and policy analysis. Empirical evidence indicates that post-policy maternal populations are characterized by advanced age, higher parity, and prolonged interpregnancy intervals. These shifts have elevated perinatal complication risks, which in turn heighten long-term cardiometabolic disease burdens and exacerbate psychological distress, with rural women disproportionately affected. While China's experience offers valuable insights for global reproductive health research, existing studies remain predominantly observational, with insufficient long-term follow-up data. We recommend optimizing maternal health services, increasing rural healthcare investment, strengthening supportive policies, and conducting long-term cohort studies to improve women's health outcomes.

KEYWORDS

Fertility policy transitions; Female health; Life course epidemiology; Urban-rural disparities

CITE THIS PAPER

Ying Zhou. Fertility Policy Transitions and Female Physical and Mental Health: Evidence from China. Social Medicine and Health Management (2026). Vol. 7, No.1, 92-99. DOI: http://dx.doi.org/10.23977/socmhm.2026.070113.

REFERENCES

[1] Zhu C , Zhang S , Shen L ,et al.Changes in the characteristics and outcomes of high-risk pregnant women who delivered prior to and after China's universal two-child policy: a real-world retrospective study, 2010–2021[J].BMC Public Health, 2024, 24(1).
[2] Li W , Ruan W , Lu Z ,et al.Parity and risk of maternal cardiovascular disease: A dose-response meta-analysis of cohort studies[J].European journal of preventive cardiology, 2019, 26(6):592-602.
[3] Wagner C , Carmeli C , Jackisch J ,et al.Life course epidemiology and public health[J].The Lancet Public Health, 2024, 9(4):9.
[4] Ganatra B , Faundes A .Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality[J].Best Practice & Research Clinical Obstetrics & Gynaecology, 2016, 36:145-155.
[5] Zhou C , Weng J , Tan F ,et al.Pregnancy-related Anxiety among Chinese Pregnant Women in Mid-late Pregnancy under the Two-Child Policy and its Significant Correlates[J].Journal of Affective Disorders, 2020, 276(1).
[6] Liu Ya-Fei , Jing H U .The More Children Raised, the More Blessings of Mother:The Impact of Number of Children on Maternal Health[J].South China Population, 2016,6:69–78.
[7] Jing,Lin,Han,et al.Long interpregnancy interval and adverse perinatal outcomes: a retrospective cohort study[J].Science China(Life Sciences), 2020, v.63(06):110-116.
[8] Andrassy K , Waldherr R , Hergesell O ,et al.Impact of advanced maternal age on pregnancy outcome.[J].American Journal of Perinatology, 2002, 19(01):001-008.
[9] Mcewen B S .Protection and Damage from Acute and Chronic Stress: Allostasis and Allostatic Overload and Relevance to the Pathophysiology of Psychiatric Disorders[J].Annals of the New York Academy of Sciences, 2004.
[10] Lueth A J , Allshouse A A , Blue N M ,et al.Can allostatic load in pregnancy explain the association between race and subsequent cardiovascular disease risk: A cohort study[J].BJOG: An International Journal of Obstetrics & Gynaecology, 2023, 130(10).
[11] Becker G S. A Theory of the Allocation of Time[J]. The economic journal, 1965, 75(299): 493-517.
[12] Wu X , Li L .Family size and maternal health: evidence from the One-Child policy in China[J].Journal of Population Economics, 2012, 25(4):1341-1364.
[13] Liu Y, Hu J. The number of children, parents’ health and life satisfaction: the perspective of sex imbalance. Northwest Popul J. (2017) 3:68–75. (in Chinese). doi: 10.15884/j.cnki.issn.1007-0672.2017.03.010
[14] Fan X, Im J, Miao L, et al. Silk and steel: A gendered approach to career and life by upper echelon women executives in the hospitality and tourism industry in China[J]. International Journal of Hospitality Management, 2021, 97: 103011.
[15] Ferraro K F, Shippee T P. Aging and cumulative inequality: How does inequality get under the skin?[J]. The Gerontologist, 2009, 49(3): 333-343.
[16] Zhang Y, Ding W, Dai X, et al. Burden of multiple high-risk factors in pregnancy before and after the universal two-child policy in Chinese women: An observational study[J]. Journal of Global Health, 2024, 14: 04134.
[17] Luo J, Fan C, Luo M, et al. Pregnancy complications among nulliparous and multiparous women with advanced maternal age: a community-based prospective cohort study in China[J]. BMC pregnancy and childbirth, 2020, 20(1): 581.
[18] Liao Z, Zhou Y, Li H, et al. The rates and medical necessity of cesarean delivery in the era of the two-child policy in Hubei and Gansu provinces, China[J]. American journal of public health, 2019, 109(3): 476-482.
[19] Sasmita B R, Golamaully S, Huang B, et al. Associations between live birth and cardiometabolic disease in Southwest Chinese women[J]. BMC Endocrine Disorders, 2024, 24(1): 175.
[20] Bai L, Yang X, Sun Z, et al. Reproductive factors and metabolic syndrome among Chinese women aged 40 years and older[J]. Journal of Diabetes, 2023, 15(1): 36-46.
[21] Sun A, Xia F, Zhang X. The motherhood penalty on health: Evidence from China[J]. Journal of Economic Behavior & Organization, 2025, 238: 107241.
[22] Lu L, Duan Z, Wang Y, et al. Mental health outcomes among Chinese prenatal and postpartum women after the implementation of universal two-child policy[J]. Journal of affective disorders, 2020, 264: 187-192.
[23] Shen M, Wu Y, Xiang X. Hukou-based rural–urban disparities in maternal health service utilization and delivery modes in two Chinese cities in Guangdong Province[J]. International Journal for Equity in Health, 2021, 20(1): 145.
[24] Qin Q, Xu B, Hu X, et al. Spatiotemporal trends and geographic disparities in spatial accessibility to maternal and child health services in Nanning, China: impact of two-child policies[J]. BMC Health Services Research, 2024, 24(1): 934.
[25] Long Q, Zhang Y, Zhang J, et al. Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys[J]. BMJ open, 2022, 12(4): e059208.

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