Abstract
BACKGROUND: China has experienced a continuous decline in fertility rates, despite the end of the one-child policy, further intensifying population ageing. Timely evidence on the factors associated with childlessness among Chinese women is needed, alongside examining reproductive anxiety among childless women of reproductive age. METHODS: This nationwide, cross-sectional study was based on the 2023 Psychology and Behavior Investigation of Chinese Residents Survey. A total of 10,802 women across mainland China who were (or had been) married were included, of whom 5,885 were of reproductive age (20-49 years) and 4,917 of post-reproductive age (≥ 50 years). Logistic and linear regression analyses were conducted to examine factors associated with childlessness among reproductive-aged and post-reproductive women, and reproductive anxiety among childless women of reproductive age at intrapersonal, interpersonal, and societal levels, as outlined in the social-ecological model. RESULTS: The comparison of reproductive patterns among women across different age groups showed a dramatic decline in the proportion of having three or more children, and a gradual increase in the childlessness over time. Among 5,885 women of reproductive age by the time of the survey, 612 (10.4%) reported having no children, while among 4,917 post-reproductive women, 161 (3.3%) were childless. Higher education level (OR = 2.83 [2.26, 3.55]; OR = 2.35 [1.44, 3.74]), being the only child in the family (OR = 2.85 [2.28, 3.55]; OR = 10.56 [7.38, 15.14]), and exposure to intimate partner violence (OR = 1.15 [1.02, 1.29]; OR = 1.68 [1.43, 1.98]) were significantly associated with childlessness among both reproductive-aged women and post-reproductive women. Poorer stress coping ability and exposure to sexual abuse during childhood were also associated with childlessness in post-reproductive women. Among childless women of reproductive age, higher education level, higher body image dissatisfaction, exposure to child abuse, parental issues during childhood, and belonging to ethnic minority groups were associated with increased reproductive anxiety. CONCLUSIONS: This study used the most recent nationwide survey data from China to identify factors associated with childlessness and reproductive anxiety, with an emphasis on socio-economic factors and domestic violence. The findings highlight the significant impact of domestic violence on fertility behaviors and reproductive anxiety, providing valuable evidence for future policy interventions.