Factors affecting fertility preferences among Chinese women of childbearing age: a multi-center Best–Worst Scaling (BWS) survey

This study utilized the Best–Worst Scaling object case (BWS-1) approach to examine fertility preferences among Chinese women of childbearing age, quantify the relative importance of various factors and explore heterogeneity across different demographic characteristics. Through a combination of literature review, expert consultations, and focus group interviews, 11 factors influencing fertility preferences were identified. Data from 863 respondents revealed the six most critical factors affecting fertility preferences were child-rearing costs, the impact of childbirth on women’s health, education costs, the impact on personal career development, housing costs, and marital disharmony. Heterogeneity analysis showed significant differences in fertility preferences across different groups. Heterogeneity analysis revealed that women’s fertility considerations varied substantially by age, educational level, income, only child status, marital status, and geographical distribution. Notably, younger women, those with postgraduate degrees, unmarried, lower-income, or only-child women expressed heightened concerns regarding the impact of childbirth on women’s health and personal career development, while regional differences highlighted varying emphases on economic costs, health, career development and medical conditions. Our findings suggest that policies aimed at increasing fertility intentions should focus on four key areas: alleviating the economic burden of raising children, strengthening health protections for women, improving the work environment for mothers, and incorporating marriage counseling into fertility support policies, along with offering related subsidies or preferential services. This study, by applying the BWS-1 approach, is the first to quantitatively assess the relative importance of factors influencing fertility preferences, providing evidence-based recommendations for targeted policy interventions and enriching the existing literature.