Temporal and regional distributions of fertility intention, behavior, and intention-behavior congruence in China (2010–2021)

Abstract Background: China’s demographic transition closely mirrors the global decline in fertility and the impending population aging in the 21st century. Consequently, China’s fertility policies have undergone drastic shifts to stimulate fertility. However, little is known about the national distribution of fertility intentions, the gap between intention and behavior, and how these trends have evolved alongside the nation’s rapid socioeconomic development over the past decade. Objective: To analyze the temporal trends and regional distributions of fertility intention and the gap between fertility intention and behavior across both genders in China from 2010 to 2021. Ultimately, this study aims to provide empirical evidence to assist policymakers in formulating future fertility policies and reproductive support systems. Methods: Data were drawn from the Chinese General Social Survey (CGSS) from 2010 to 2021, a nationwide repeated cross-sectional social survey using a stratified four-stage unequal probability sampling method. Fertility intention, behavior, and the congruence between the two were assessed. The annual trends were analyzed by calculating the annual percentage change and conducting nonlinear regression. Results: A total of 38,744 individuals across 28 provinces were involved in the analysis. From 2010 to 2021, the national rate of individuals with second-child fertility intention among the eligible population fluctuated around 75%. Conversely, both the behavior rate and the intention-behavior congruence rate showed a U-shaped trend, with the lowest point of the former in 2013 (26.0%) and the latter in 2015 (47.9%), with an increasing trend following the implementation of the universal two-child policy. Gender differences were not significant in fertility intention and behavior. The majority of provinces exhibited a declining trend in fertility intention rates, with the exception of several northeastern and western regions. Finally, most coastal provinces experienced an increase in congruence rates, while northeastern and inland regions witnessed a decrease. Conclusions: The relaxation of fertility policies has been followed by a significant narrowing of the fertility intention-behavior gap; however, fertility intentions did not show a sustained increase. Different regions and populations have varied responses after the policy adjustments, as populations aged 35–49 and coastal areas are more sensitive to the changes. This study highlights the urgent need for policymakers to prioritize and implement comprehensive supportive measures to establish a fertility-friendly society.