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. 2024 May 16;11(5):e2178. doi: 10.1002/nop2.2178

Intention to have a third child among millennial parents with two children in eastern China: A cross‐sectional survey

Fen Xu 1, Shen‐jun Jiang 2, Pan‐pan Ge 3, Jue Yang 3, Sha Lu 4,✉
PMCID: PMC11099693  PMID: 38757435

Abstract

Aim

This Study Aimed to Assess the Intention to Have a Third Child among Millennial Parents (25–40 years old) with Two Children in a City in Eastern China and to Explore the Influencing Factors Related to Fertility Intention.

Design

A cross‐sectional design study.

Methods

A convenience sampling method was used to enrol participants of childbearing age who visited two tertiary hospitals in Hang zhou, a city in eastern China, from June 2021 to March 2022. We conducted a face‐to‐face questionnaire survey with 520 participants and calculated the prevalence of intention‐related factors. Multivariate logistic regression was used to analyse the independent influencing factors of fertility intention.

Results

In total, 105 (20.2%) participants had the intention to have a third child. The results showed that ‘employment status’, ‘age’, ‘reasons for wanting a third child’, the considered ‘biggest barrier to having a third child’, ‘views on the three‐child policy’, ‘desired free services’, ‘supporting work policies’ and ‘assistance policies’ were significant independent influencing factors of intention to have a third child (p‐value < 0.05). The intention of the participants ‘over 30 years old’ was 2.466 times that of those ‘30 years old and under’, and ‘older age/personal health status’ was considered the ‘biggest barrier to having a third child’. Regarding policy and social reasons, the participants who need ‘medical assistance’ policy negatively affect the intention to have a third child (OR = 0.453, 95% CI = 0.247–0.830).

Implications for Healthcare/Nursing

Nursing plays an important role in health promotion. Nurses can help couples make wise decisions about fertility by providing professional consultation, education, evaluation and support. They can also provide corresponding nursing and guidance to improve couples' health quality and overall reproductive success.

Conclusions

The general level of intention to have a third child of Millennial parents with two children is still low. The participants who are ‘housewives/househusbands’, ‘over 30 years old’, and satisfied with the state of ‘medical assistance’ have higher fertility intentions.

Patient or Public Contribution

It is particularly meaningful for the policymakers to improve the social support system and raise universal awareness to encourage childbirth.

Keywords: fertility intention, influencing factors, millennial parents, three‐child

1. BACKGROUND

The decline in the global birth population has become an inevitable trend, which has aroused widespread concern in the international community (Giuntella et al., 2022). To encourage fertility, after more than 30 years of implementing the family planning policy (one‐child policy), the number of births in China increased slightly after the universal two‐child policy was introduced in 2015. And the national total fertility rate further rose to approximately 1.8 in 2017 (Zhuang et al., 2020). However, the Seventh National Population Census in 2021 showed that the number of births in China has declined for four consecutive years, from 18.83 million in 2016 to 12 million in 2020; the total fertility rate even dropped to 1.3 in 2020 (National Bureau of Statistics, 2021). The low‐fertility rate is considered to be a major factor hindering the long‐term prosperity of the country; on the one hand, the decrease in the number of births will result in declining labour, labour force, rising labour, labour costs and a shrinking economy; on the contrary, the decline in fertility will accelerate the ageing of the population, placing greater pressure on public finance, social security, pension systems, elderly care services and health care (Parsons & Gilmour, 2018). Considering that China is a country with a large population base, the above issues may become even more severe due to the low‐fertility rate.

Facing declining fertility, many developed countries have introduced fertility‐related policies, which have been found to generate positive fertility responses (Kalwij, 2010). In 2021, China introduced the three‐child policy, which indicates that China has gradually moved from limiting birth to encouraging birth (National Health Commission of the People's Republic of China, 2021). Fertility intention plays an important role in predicting fertility behaviour and is the main driving force of fertility behaviour and fertility change in the era of low fertility (Dommermuth et al., 2015; Mencarini et al., 2015), particularly in China. China's modern concept of fertility has changed compared with the traditional concept, especially among those born after 1980. The Millennial parents (25–40 years old) have gradually broken away from the shackles of the traditional fertility value system; furthermore, the utilitarian demand for the number of births and children has decreased, while the emotional demand has increased, and attention has been given to children's upbringing and self‐value realization (Yang & Wu, 2021). However, there are few studies on fertility intention after the release of the three‐child policy, especially among Millennial parents with two children (Yan, 2023). Therefore, the purpose of this study was to investigate the fertility intention of Millennial parents to have a third child and to analyse the factors affecting fertility intention to provide a reference point for proposing effective practical policies related to low fertility.

Nursing plays an important role in health promotion (Johnson & Stellwag, 2022). Nurses are the invaluable bridge between doctors and their patients, as they are the actual executors of many medical orders. Therefore, nurses are closer and more familiar with couples than doctors, and for these reasons, couples are more willing to share their real thoughts with nurses, which also helps nurses propose targeted interventions. In addition, nurses have both knowledge of medicine and nursing, and they can provide professional consultation, education, evaluation, and support to couples, and this in turn makes couples to be more willing to follow the advice of nurses to improve their health. Moreover, psychological care is another important part of fertility promotion, and nurses can provide corresponding healthcare and guidance to help couples make wise decisions, thereby maximizing their health quality and overall reproductive success. Hence, to make the final results more meaningful and practical, nurses were the main implementers and communicators in this study.

2. SUBJECTS AND METHODS

2.1. Subjects

A cross‐sectional design and convenience sampling method was used to enrol participants of childbearing age who visited four two hospitals in Hangzhou, a city in eastern China, from June 2021 to March 2022. The inclusion criteria were as follows: (1) Millennial parents, ages 25 to 40; (2) have two children and not pregnant with a third child and (3) willing to cooperate with the study. The exclusion criteria included people who are currently suffering from serious physical illness, mental illness or cognitive impairment. All the subjects signed an informed consent form.

The participants were divided into two groups (the intent group and the no‐intent group) according to whether they intended to have a third child.

2.2. Measurements

A face‐to‐face questionnaire survey was conducted by midwives and nurses. The questionnaire was created according to the literature review (Huang, 2020; Pan, 2021) and included 3 major items in total:

  1. General demographic characteristics: ‘gender’, ‘age’ (30 years old and under, >30 years old), ‘residence’ (urban or rural), ‘education’, ‘employment status’, ‘monthly household income’ and ‘number of siblings’ (only him/herself, 1 sibling, 2 and more siblings).

  2. Individual and family factors related to the intention to have a third child: ‘reasons for wanting a third child’ (single choice: children support each other, raise children to provide against old age/reducing pension risks, just love children, want a boy/girl), ‘economic tendency to raise children’ (single choice: raise in frugality or abundance, raise in abundance) and the considered ‘biggest barrier to having a third child’ (single choice: economic reasons, lack of support from one's family, having no time to take care of children, older age/personal health status).

  3. Policy and social factors related to the intention to have a third child: ‘understanding of the three‐child policy’ (single choice: detailed understanding, only heard of it), ‘views on the three‐child policy’ (single choice: neutral, supported, opposed), ‘application of the three‐child policy’ (single choice: population ageing, heavy burden of an only child, incomplete safeguard policies, labour shortage), ‘impact of the three‐child policy’ (multiple choice: mitigate population ageing, promote social stability and development, optimize the reorganization of labour force, concerns about population explosion, other concerns), ‘mostly wanted to know before having another child’ (multiple choice: eugenics, contraception, health, laws and regulations), ‘desired free services’ (multiple choice: pre‐pregnancy examination, legal consultation, regular reproductive health examination, childcare guidance), ‘supporting work policies’ (multiple choice: overtime bans, paid annual leave, delay retirement, others) and ‘assistance policies’ (multiple choice: medical assistance, childhood education assistance, housing assistance, childcare assistance, female employment assistance, other assistance).

2.3. Statistical methods

SPSS 25.0 software (IBM, Armonk, NY, USA) was used for statistical analysis. The data were described by the number of cases (percentage), and Chi‐squared analysis was used for categorical variables between groups. Multivariate logistic regression was used to analyse the independent influencing factors of fertility intention. p‐value < 0.05 was considered to be significant. All tests were two‐tailed analyses.

In this study, logistic regression was used to analyse the significant independent influencing factors of fertility intention, and the sample size estimation module of logistic regression analysis in PASS 15.0 (NCSS LLC, Kaysville, UT, USA) was used. The parameters were set as follows: power β = 0.9, α = 0.05, baseline probability P0 [PR (y = 1 | x = 0)] = 0.05, odds ratio P1 [PR (y = 1 | x = 1)] 75%. The minimum sample size required for this study was calculated to be N = 217.

3. RESULTS

3.1. Characteristics of the study population

A total of 520 participants completed all the procedures in the study (Table 1). Among them, 105 (20.2%) participants intended to have a third child. The majority of participants were women (n = 471, 90.6%), and more than half (n = 313, 60.2%) of the participants lived in urban areas. The number of participants with a college degree or below was approximately four times that of those with a master's degree or above. In terms of ‘employment status’, workers/clerks comprised the largest percentage of participants (n = 243, 46.7%), and nearly 90.0% (n = 454, 87.3%) of the respondents had a moderate or above household income. More than 70.0% (n = 376, 72.3%) of the participants had siblings.

TABLE 1.

Characteristics of all participants.

Characteristic Number (%) Intention to have a third child p‐value
No (n = 415) Yes (n = 105)
Gender 0.067
Men 49 (9.4) 44 (10.6) 5 (4.8)
Women 471 (90.6) 371 (89.4) 100 (95.2)
Age <0.001**
30 years old and under 377 (72.5) 316 (76.1) 61 (58.1)
>30 years old 143 (27.5) 99 (23.9) 44 (41.9)
Residence 0.623
Urban 313 (60.2) 252 (60.7) 61 (58.1)
Rural 207 (39.8) 163 (39.3) 44 (41.9)
Education 0.145
College or below 422 (81.2) 342 (82.4) 80 (76.2)
Master or above 98 (18.8) 73 (17.6) 25 (23.8)
Employment status <0.001**
Housewives/househusbands 36 (6.9) 16 (3.9) 20 (19.0)
Workers/clerks 243 (46.7) 185 (44.6) 58 (55.2)
Public servants 154 (29.6) 140 (33.7) 14 (13.3)
Individual businesses 38 (7.3) 25 (6.0) 13 (12.4)
Others 49 (9.4) 49 (11.8) 0 (0.0)
Monthly household income (CNY ¥) 0.698
<8000 66 (12.7) 55 (13.3) 11 (10.5)
8000–14,999 157 (30.2) 123 (29.6) 34 (32.4)
15,000 and above 297 (57.1) 237 (57.1) 60 (57.1)
Siblings 0.063
Only him/herself 144 (27.7) 122 (29.4) 22 (20.9)
1 274 (52.7) 208 (50.1) 66 (62.9)
2 and more 102 (19.6) 85 (20.5) 17 (16.2)
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Note: **p‐value < 0.01.

The proportion of participants ‘over 30 years old’ who wanted to have a third child was higher than that of those ‘30 years old and under’ (p‐value < 0.01). There was a significant difference in terms of ‘employment status’ (p‐value < 0.01), and there were no significant differences in the comparison of different genders, generation of birth, residence, education, monthly household income and siblings between the two groups (p‐value > 0.05) (Table 1).

3.2. Individual and family factors of the intention to have a third child

Among all the participants, the highest percentage of the ‘reasons for wanting a third child’ was that the ‘children support each other’ (n = 353, 67.9%). More than 90.0% (n = 486, 93.5%) of the participants considered ‘raising children in abundance’. The ‘biggest barrier to having a third child’ was ‘having no time to take care of children’ (n = 228, 43.8%). There was a significant difference in terms of ‘reasons for wanting a third child’ (p‐value < 0.05) and ‘biggest barrier to having a third child’ (p‐value < 0.01), respectively. However, there were no significant differences in the ‘economic tendency to raise children’ between the two groups (p‐value > 0.05) (Table 2).

TABLE 2.

Individual and family factors of the intention to have a third child.

Characteristic Number (%) Intention to have a third child p‐value
No (n = 415) Yes (n = 105)
Reasons for wanting a third child 0.011*
Children support each other 353 (67.9) 296 (71.3) 57 (54.3)
Raise children to provide against old age/reduce pension risks 30 (5.8) 21 (5.1) 9 (8.6)
Just love children 102 (19.6) 73 (17.6) 29 (27.6)
Want a boy/girl 35 (6.7) 25 (6.0) 10 (9.5)
Economic tendency to raise children 0.953
Raise in frugality or abundance 34 (6.5) 27 (6.5) 7 (6.7)
Raise in abundance 486 (93.5) 388 (93.5) 98 (93.3)
Biggest barrier to having a third child <0.001**
Economic reasons 197 (37.9) 162 (39.0) 35 (33.3)
Lack of support from one's family 54 (10.4) 50 (12.0) 4 (3.8)
Having no time to take care of children 228 (43.8) 181 (43.6) 47 (44.8)
Older age/personal health status 41 (7.9) 22 (5.3) 19 (18.1)
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Note: *p‐value < 0.05, **p‐value < 0.01.

3.3. Policy and social factors of the intention to have a third child

In total, 62.7% (n = 326) of the participants' views on the three‐child policy were neutral. The participants who supported the three‐child policy had a higher intention to have a third child than those who opposed the policy (p‐value < 0.05). More than 50% (n = 299, 57.5%) of the participants thought the most common ‘application of the three‐child policy’ was population ageing. Compared with the no‐intent group, the proportion of participants who thought this policy applied to the ‘heavy burden of an only child’ and ‘incomplete safeguard policies’ was higher, while ‘population ageing’ and ‘labour shortage’ were lower in the intent group (p‐value < 0.05). Among those who thought the three‐child policy would ‘optimise the reorganization of the labour force’, the proportion in the intent group was higher than that in the no‐intent group (p‐value < 0.05). The intent group had lower needs for ‘legal consultation’, thereby ‘supporting work policies’ such as ‘overtime bans’, ‘paid annual leave’, ‘medical assistance’, ‘housing assistance’ and ‘female employment assistance’ more so than the other group (p‐value < 0.01). There was no significant difference in other characteristics of policy and social reasons between the two groups (p‐value > 0.05) (Table 3).

TABLE 3.

Policy and social factors of the intention to have a third child.

Characteristic Number (%) Intention to have a third child p‐value
No (n = 415) Yes (n = 105)
Views on the three‐child policy 0.034*
Neutral 326 (62.7) 263 (63.4) 63 (60.0)
Supported 142 (27.3) 105 (25.3) 37 (35.2)
Opposed 52 (10.0) 47 (11.3) 5 (4.8)
Understanding of the three‐child policy 0.347
Detailed understanding 199 (38.3) 163 (39.3) 36 (34.3)
Only heard of it 321 (61.7) 252 (60.7) 69 (65.7)
Application of the three‐child policy 0.038*
Population ageing 299 (57.5) 243 (58.6) 56 (53.3)
The heavy burden of an only child 113 (21.7) 88 (21.2) 25 (23.8)
Incomplete safeguard policies 70 (13.5) 49 (11.8) 21 (20.0)
Labor shortage 38 (7.3) 35 (8.4) 3 (2.9)
Impact of the three‐child policy (multiple‐choice question)
Mitigate population ageing 434 (83.5) 341 (82.2) 93 (88.6) 0.115
Promote social stability and development 233 (44.8) 189 (45.5) 44 (41.9) 0.503
Optimize the reorganization of the labor force 319 (61.3) 245 (59.0) 74 (70.5) 0.032*
Concerns about population explosion 69 (13.3) 55 (13.3) 14 (13.3) 0.983
Other concerns 49 (9.4) 41 (9.9) 8 (7.6) 0.479
Mostly wanted to know before having a child (multiple‐choice question)
Eugenics 415 (79.8) 331 (79.8) 84 (80.0) 0.956
Contraception 236 (45.4) 189 (45.5) 47 (44.8) 0.886
Health 426 (81.9) 336 (81.0) 90 (85.7) 0.258
Laws and regulations 244 (46.9) 200 (48.2) 44 (41.9) 0.249
Desired free services (multiple‐choice question)
Pre‐pregnancy examination 368 (70.8) 297 (71.6) 71 (67.6) 0.427
Legal consultation 301 (57.9) 256 (61.7) 45 (42.9) <0.001**
Regular reproductive health examination 432 (83.1) 350 (84.3) 82 (78.1) 0.128
Childcare guidance 461 (88.7) 364 (87.7) 97 (92.4) 0.178
Supporting work policies (multiple‐choice question)
Overtime bans 303 (58.3) 256 (61.7) 47 (44.8) 0.002**
Paid annual leave 448 (86.2) 368 (88.7) 80 (76.2) 0.001**
Delay retirement 217 (41.7) 171 (41.2) 46 (43.8) 0.629
Others 103 (19.8) 77 (18.6) 26 (24.8) 0.154
Assistance policies (multiple‐choice questions)
Medical assistance 391 (75.2) 326 (78.6) 65 (61.9) <0.001**
Childhood education assistance 437 (84.0) 350 (84.3) 87 (82.9) 0.711
Housing assistance 412 (79.2) 337 (81.2) 75 (71.4) 0.027*
Childcare assistance 402 (77.3) 326 (78.6) 76 (72.4) 0.177
Female employment assistance 396 (76.2) 327 (78.8) 69 (65.7) 0.005**
Other assistance 28 (5.4) 21 (5.1) 7 (6.7) 0.515
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Note: *p‐value < 0.05, **p‐value < 0.01.

3.4. Logistic regression analysis for factors impacting intention to have a third child

Multivariate logistic regression analysis was conducted for statistically significant variables of the above single‐factor analysis. The results showed that ‘employment status’ (p‐value < 0.01), ‘age’ (p‐value < 0.01), ‘biggest barrier to having a third child’ (p‐value < 0.01), and ‘medical assistance’ of ‘assistance policies’ (p‐value < 0.05) were significant independent influencing factors of the intention to have a third child (Table 4). The results are also represented in the form of a forest plot (Figure 1).

TABLE 4.

Logistic regression analysis for factors impacting intention to have a third child.

Variables B SE Wald p‐value OR (95% CI)
Employment status 35.76 < 0.001**
Housewives/househusbands 1.00
Workers/clerks −2.01 0.47 18.70 < 0.001** 0.13 (0.05–0.33)
Public servants −3.04 0.51 35.26 < 0.001** 0.05 (0.02–0.13)
Individual businesses −1.58 0.58 7.46 0.006** 0.21 (0.07–0.64)
Age
30 years old and under 1.00
>30 years old 0.90 0.28 10.45 0.001** 2.47 (1.43–4.26)
Reasons for wanting a third child 5.99 0.112
Children support each other 1.00
Raise children to provide against old age/reduce pension risks −0.26 0.55 0.23 0.635 0.77 (0.27–2.25)
Just love children 0.50 0.32 2.37 0.124 1.65 (0.87–3.10)
Want a boy/girl 1.10 0.53 4.30 0.038* 3.00 (1.06–8.46)
Biggest barrier to having a third child 17.67 0.001**
Economic reasons 1.00
Lack of support from one's family −1.54 0.65 5.60 0.018* 0.22 (0.06–0.77)
Having no time to take care of children 0.35 0.31 1.30 0.254 1.42 (0.78–2.58)
Older age/personal health status 1.35 0.43 9.67 0.002** 3.84 (1.64–8.96)
Views on the three‐child policy 4.14 0.127
Neutral 1.00
Supported 0.58 0.29 3.98 0.046* 1.79 (1.01–3.16)
Opposed 0.43 0.56 0.59 0.443 1.54 (0.51–4.66)
Desired free services
Legal consultation −0.12 0.27 0.19 0.663 0.89 (0.53–1.50)
Supporting work policies
Overtime bans 0.10 0.32 0.09 0.765 1.10 (0.59–2.05)
Paid annual leave −0.55 0.39 1.93 0.164 0.58 (0.27–1.25)
Assistance policies
Medical assistance −0.79 0.31 6.57 0.010* 0.45 (0.25–0.83)
Housing assistance −0.17 0.33 0.28 0.598 0.84 (0.44–1.60)
Female employment assistance 0.24 0.35 0.47 0.493 1.27 (0.64–2.53)
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Abbreviations: CI, confidence interval; OR, odds ratio; SE, standard error.

*p‐value < 0.05, **p‐value < 0.01.

FIGURE 1.

FIGURE 1

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Factors impacting intention to have a third child.

Compared with ‘housewives/househusbands’, those with ‘public servant employment’ status had the lowest intention to have a third child. The intention of participants ‘over 30 years old’ to have a third child was 2.466 times that of those ‘30 years old and under’. ‘Lack of support from one's family’ had the least impact on the intention to have a third child compared with economic reasons, and ‘older age/personal health status’ was the biggest barrier to having a third child.

For policy and social reasons, the participants who need ‘medical assistance’ stated that such policies negatively affect their intention to have a third child (OR = 0.453, 95% CI = 0.247–0.830). It can be considered that those who do not want to have a third child believe that the current availability of medical assistance does not meet the expected needs of having a third child (Table 4).

4. DISCUSSION

This study analysed the fertility intention of having a third child among Millennial parents with two children through a questionnaire in China. Overall, participants stated a low intention to have a third child, which was lower than the second birth intention after the universal two‐child policy was introduced (39.4%–69.3%) (Lau et al., 2018; Lian & Xiong, 2020; Liu et al., 2019).

We found that the proportion of participants ‘over 30 years old’ who wanted to have a third child was higher than that of participants' ‘30 years old and under’, which reflects that older couples desired more children than younger couples. This is consistent with the findings of a fertility desire study in Bangladesh (Akram et al., 2020). Our study showed that the reason for ‘older age/personal health status’ is considered to be the biggest barrier to having a third child, which may explain the previous phenomenon. Increasing age at childbirth leads to decreased fertility and increased risk of maternal and neonatal complications (Moghadam et al., 2022), which affects maternal quality of life. Fertility intention is not stable and may change as conditions change (Iacovou & Tavares, 2011). Older participants are worried about their increasing age; therefore, their urgency and intention of having a third child are higher than those of young people. Other cross‐sectional surveys have also demonstrated that ‘older age/personal health status’ is the biggest barrier to having a third child (Kang et al., 2022; Yan et al., 2021). Some studies have shown that it is necessary to adopt fertility‐friendly policies and family intervention institutions to reduce the potential adverse consequences and improve the quality of life of women after childbirth to make the policy of encouraging fertility successful (Jing et al., 2022; Liu & Zhou, 2019; Zhang, Li, & Tang, 2022). Our survey also showed the need for such policies. Therefore, the government and health care departments should strengthen the medical service guarantee for women with advanced maternal age; provide high‐quality medical resources, such as community health departments that provide home or remote guidance; provide pre‐pregnancy health education and information (Daniluk & Koert, 2015; Williamson et al., 2014); intervene and reduce the possible risks, and increase the intention and confidence of advanced couples to give birth. The rapid maternal recovery model should also be carried out to reduce the impact of production on the body and life.

Our study demonstrated that ‘employment status’ was an important factor affecting fertility intentions, and the intention of ‘housewives/househusbands’ to have a third child was higher than that of ‘workers/clerks’ and ‘public servants’. The fertility rate will affect women's employment, and the number of children will affect women's working time and income (Finlay, 2021). Another study found that increasing women's labour force participation and educational opportunities would reduce women's desire to have children (Codazzi et al., 2018). Qiu (2022) believed that the weakening of fertility intention was due to the entry of the labour market, which increased the cost of fertility and promoted the independent choice of fertility, resulting in the difficulty of balancing work and fertility. Our study also showed that ‘having no time to take care of children’ is an important factor affecting fertility intention. Many women with high‐education levels are more conducive to ‘eugenics’. However, they often have no time to take care of multiple children due to work restrictions, which reduces their level of competitiveness. Even if they are full‐time housewives, their excellence and enterprising spirit are often troubled by trivial family problems. Some scholars have proposed that public policies based on the perspective of fertility intention should focus on reducing the gap between fertility desire and actual childbearing behaviour (Islam & Bairagi, 2003; Wang & Wang, 2022). In the new era, parents are more interested in the process and quality of their children's cultivation (Zhu et al., 2022), while childcare guidance has a significant impact on fertility intention, which is especially affected by economic costs, time and energy, and factors related to children's growth (Li, 2022; Zhang, Li, & Tang, 2022; Zhang, Li, & Tang, 2022). In this study, although there was no significant difference in childcare guidance between the two groups, this factor had the highest proportion in each group. Thus, the social support system is obligated to provide not only more complete and systematic childcare and education services (Rhee, 2007) but also high‐quality and fair education for families with multiple children. Family support policies should be adopted that support work‐family balance (Ji & Jung, 2021) and reproductive welfare to reduce the cost of fertility and education, meet the need for access to high‐quality parenting resources, reduce the time cost and economic burden of parents in the process of parenting, and effectively ‘boost’ fertility intention.

Furthermore, Barbos and Milovanska‐Farrington (2019) found that paid maternity leave improved families' intention to bear children, especially those with two children. Our study showed that ‘paid annual leave’ was also an independent factor affecting fertility intention. Therefore, if we want to improve fertility intentions, we should improve the supporting policies and legal protection for families in terms of employment, vacation and welfare treatment, especially to protect the interests of women. For example, employees should not be dismissed within a few years of giving birth, and they should be provided with regular and long‐term paid leave benefits (Baizan et al., 2016) and long‐term parenting subsidies (Spéder et al., 2020). Parenting is a long‐term process, which is not reflected in a one‐time subsidy paid after giving birth; thus, families with multiple children should have no worries at home and be able to reduce the conflict between parenting and work.

According to Confucianism in China, the more children there are, the more happiness there is. By tradition, raising children helps one provide against old age, thus reducing pension risk. However, such concepts have changed in the Millennial parents. This change is consistent with the lowest proportion of ‘raise children to provide against old age/reducing pension risks’ in the analysis of the ‘reasons for wanting a third child’ portion of this study. Logistic regression analysis showed that the highest‐rated reason for wanting a third child was ‘want a boy/girl’. Most of these families have only boys or girls at present and want to achieve a ‘child of another gender’. This finding is similar to the results of other studies (Mishra & Parasnis, 2022; Ning et al., 2022; Park et al., 2021). The second reason for wanting a third child is ‘just love children’. Some scholars have also proposed that the education and publicity of the fertility concept should excavate the positive and reasonable factors in the traditional fertility culture, emphasize the happiness of fertility to people of childbearing age from the standpoint of individuals and families, and reshape the significance of fertility to people of childbearing age and their families (Yang & Wu, 2021). The community can publicise the benefits of families with multiple children and invite families with multiple children to share experiences as positive teaching materials to improve the confidence of having three children. At the same time, the media will aim to reduce the publicity of ‘involution’ and ‘elite’ culture and alleviate public anxiety.

This study has several limitations. First, the male participation rate in this study is low. When men were invited to participate, they thought it was their wife's business and refused to become involved. Thus, we are also interested in conducting further research at a gender‐matched level. Second, this cross‐sectional survey was performed in a relatively wealthy city in eastern China, which may only reflect the local situation. Our study showed that the fertility intention to have a third child was higher than that in some studies (Ning et al., 2022; Yan et al., 2021). This may be because the household income, which is always positively related to life satisfaction and happiness (FitzRoy & Nolan, 2022), in this study is relatively good. Higher levels of household income (Yan et al., 2021) or subjective happiness (Mencarini et al., 2018) are associated with a higher fertility intention in countries or regions with low‐fertility rates. However, the culture and information access of people in the same region may be similar, which also helps to give corresponding suggestions to the local government. Third, this study did not investigate the age of the two existing children in the examined households. This may also affect the couple's current fertility decision regarding a third child. Thus, further investigation is needed and we plan to further expand the sample size in the following study.

5. CONCLUSIONS

Since the introduction of the new three‐child policy, the general level of intention to have a third child of Millennial parents with two children is not high. The participants who are ‘housewives/househusbands’, ‘over 30 years old’, and satisfied with the state of ‘medical assistance’ have higher fertility intentions. Therefore, to stimulate the fertility intention of the childbearing age population, it is particularly meaningful to improve the social support system for multi‐child families, increase obstetric medical resources and strengthen perinatal health care, improve legal protection and supporting policies for parents with multiple children, and raise universal awareness to encourage childbirth, all of which is worthy of attention by policy‐makers.

AUTHOR CONTRIBUTIONS

Study design: FX, SL; Data collection: FX, SJ, PG, JY; Data analysis: FX, SL; Study supervision: SL; Manuscript writing: FX. All authors have approved the submitted version of the manuscript. All authors read and approved the final manuscript.

FUNDING INFORMATION

This work was supported by the Natural Science Foundation of Zhejiang Province (LQ21H040001), Zhejiang Traditional Chinese Medicine Science and Technology Program (Grant 2023ZF151).

CONFLICT OF INTEREST STATEMENT

The authors declare no potential conflicts of interest with respect to the research, authorship and publication of this article.

ETHICS STATEMENT

The study was approved by the ethics committee at Hangzhou Women's Hospital (No. 2022K‐01‐01) and implemented by the Declaration of Helsinki. All participants provided written informed consent.

ACKNOWLEDGEMENTS

We are very grateful to every patient and participant in this article.

Xu, F. , Jiang, S.‐j. , Ge, P.‐p. , Yang, J. , & Lu, S. (2024). Intention to have a third child among millennial parents with two children in eastern China: A cross‐sectional survey. Nursing Open, 11, e2178. 10.1002/nop2.2178

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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