Does elderly care suppress women’s fertility intentions? Quasi-experimental evidence from China’s home and community-based services reform

China's recent expansion of Home- and Community-Based Services (HCBS) may influence fertility intentions among women of childbearing age. Using data from the China Labor-force Dynamics Survey (CLDS, 2014-2018) and a multi-period difference-in-differences (DID) design, we examine the effect of HCBS reforms on women's fertility expectations and explore the channels through which these reforms operate. Our results show that HCBS expansion significantly reduces fertility intentions, with an average decline of approximately 0.12 children per woman. The effect is stronger among women with siblings, those who already have children, rural residents, and women in their prime childbearing years (aged 25-34 years). Mechanism analysis indicates that this reduction is mediated by increased perceived community safety, greater participation in pension insurance, and higher economic satisfaction. These findings suggest that elderly care policies can shape reproductive decisions, highlighting the need for integrated strategies that address both ageing and fertility concerns in China.

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Publication Details

Journal
Health Economics Policy and Law
Published
2026-03-31
DOI
https://doi.org/10.1017/s1744133126100449
Primary Topic
Demographic Trends and Gender Preferences
Type
article
Field-Weighted Citation Impact
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article

Does elderly care suppress women’s fertility intentions? Quasi-experimental evidence from China’s home and community-based services reform

Yunhui Wang, Zhiying Li, Longhua Zheng
Health Economics Policy and Law
Demographic Trends and Gender Preferences
article

Does elderly care suppress women’s fertility intentions? Quasi-experimental evidence from China’s home and community-based services reform

Yunhui Wang, Zhiying Li, Longhua Zheng
article en

Abstract

China's recent expansion of Home- and Community-Based Services (HCBS) may influence fertility intentions among women of childbearing age. Using data from the China Labor-force Dynamics Survey (CLDS, 2014-2018) and a multi-period difference-in-differences (DID) design, we examine the effect of HCBS reforms on women's fertility expectations and explore the channels through which these reforms operate. Our results show that HCBS expansion significantly reduces fertility intentions, with an average decline of approximately 0.12 children per woman. The effect is stronger among women with siblings, those who already have children, rural residents, and women in their prime childbearing years (aged 25-34 years). Mechanism analysis indicates that this reduction is mediated by increased perceived community safety, greater participation in pension insurance, and higher economic satisfaction. These findings suggest that elderly care policies can shape reproductive decisions, highlighting the need for integrated strategies that address both ageing and fertility concerns in China.

Health Economics Policy and Law
Chinese Academy of Social Sciences (CN), Sichuan University (CN), Jining University (CN), University of Chinese Academy of Social Sciences
Gender equality
Openalex Percentile: Top 32%
Demographic Trends and Gender Preferences
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