Application of the Theory of Planned Behavior to couples' fertility decision-making in Inner Mongolia, China

• Published in: PloS one Vol. 14; no. 8; p. e0221526
• Main Authors: Li, Xinhua, Fan, Yancun, Assanangkornchai, Sawitri, McNeil, Edward B
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 23.08.2019; Public Library of Science (PLoS)
• Subjects: Adult; Aging; Analysis; Biology and Life Sciences; Birth rate; Child rearing; Children; Children & youth; China; Couples; Decision analysis; Decision Making; Decision theory; Education; Education policy; Epidemiology; Ethnic factors; Family Characteristics; Family planning; Family Planning Policy; Fertility; Fertility - physiology; Health policy; Health services; Higher education; Humans; Infertility; Infrastructure (Economics); Kindergarten; Marriage; Married women; Medicine; Medicine and Health Sciences; Middle Aged; Minorities; Minority & ethnic groups; Models, Theoretical; Newborn infants; Norms; People and Places; Personal relationships; Physical Sciences; Planning; Population; Questionnaires; Regression Analysis; Researchers; Rural areas; Sex; Sex ratio; Sexual Behavior; Social norms; Social Sciences; Socioeconomic factors; Studies; Womens health; Young Adult; China; Thailand; Inner Mongolia China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0221526

China relaxed its family planning policy and adopted a universal two-child policy on January 1, 2016 to actively address the country's aging trend. However, the policy has failed to have any significant effect on the fertility rate of many provinces. In light of the country having the highest sex ratio at birth in the world and the huge burden of the aging population, improving the fertility rate is an urgent priority in China. This facility-based cross-sectional survey aimed to study determinants of fertility decision-making among couples based on the Theory of Planned Behavior. The study was conducted in Inner Mongolia Autonomous Region of China. A structured self-administered questionnaire was completed by 1,399 couples, consisting of wives aged 20-49 years and their husbands. Based on the structural equation modeling method of analysis, determinants of fertility decision-making were perceived behavior control (perceived importance of having a stable income and cost of raising a child), subjective norms (perceived social pressure about "sex preference of the newborn by themselves and their partner") and attitudes (only healthy parents can have a child). Other significant factors influencing fertility decision were ethnicity and education level, with ethnic minority couples having less perception of social norm towards fertility and those with higher education having higher perceived control toward having a (further) child. The study reveals the importance of the China's infrastructure and public facilities to support child-rearing to increase the fertility rate among couples of child-bearing age, which in turn will reduce the burden associated with an aging society.