Impact of the One-Child Policy on Reproductive Decision-Making Among People of Chinese Descent in the United States:...

China's one-child policy was implemented in 1980 primarily through mandatory intrauterine devices, tubal surgery, or abortion for "unauthorized pregnancies." While it was replaced in 2015, it affected millions of persons and its effects on reproductive decision making are not well known.

We designed, validated, and performed a cross-sectional survey of reproductive age Chinese-born or first-generation women of Chinese descent to describe the policy's impact on reproductive decision-making. Descriptive statistics and multivariate logistic regression were used to identify self-reported policy impact on contraceptive utilization and childbearing choices, and demographic associations.

Between June 1 and October 31, 2021, 1098 people accessed the survey, and 838 were eligible. A total of 588 responded to questions pertaining to the primary outcome, yielding a response rate of 70.2%. Approximately 42% of participants lived under the policy and were affected by it in some way. 17.3% of participants stated their contraceptive utilization was affected and 23.3% stated their childbearing choices were affected. Those with low acculturation scores (OR = 2.27, 95% CI 1.35-3.85, p = 0.002) and those living in the United States for < 21 years (OR = 2.25, 95% CI 1.09-4.67, p < 0.01) were more likely to report their contraceptive plans were affected. 72.8% of participants self-reported high reproductive autonomy, whereas acculturation was mixed.

Although the one-child policy has had a large effect on people of the Chinese diaspora, its impact on reproductive decision-making may decrease with the duration of time in the United States and increasing acculturation.