Work

Does elderly care suppress women’s fertility intentions? Quasi-experimental evidence from China’s home and community-based services reform

Year: 2026

Type: article

Abstract: China's recent expansion of Home- and Community-Based Services (HCBS) may influence fertility intentions among women of childbearing age. Using data from the China Labor-force Dynamics Survey (CLDS, 2014-2018) and a multi-period difference-in-differences (DID) design, we examine the effect of HCBS reforms on women's fertility expectations and explore the channels through which these reforms operate. Our results show that HCBS expansion significantly reduces fertility intentions, with an average decline of approximately 0.12 children per woman. The effect is stronger among women with siblings, those who already have children, rural residents, and women in their prime childbearing years (aged 25-34 years). Mechanism analysis indicates that this reduction is mediated by increased perceived community safety, greater participation in pension insurance, and higher economic satisfaction. These findings suggest that elderly care policies can shape reproductive decisions, highlighting the need for integrated strategies that address both ageing and fertility concerns in China.

Source: Health Economics Policy and Law

DOI: 10.1017/s1744133126100449

Authors: Zhiying Li, Longhua Zheng, Yunhui Wang

Institutions: University of Chinese Academy of Social Sciences, Sichuan University

Language: English

Topic: Demographic Trends and Gender Preferences

Subfield: Gender Studies

Field: Social Sciences

Domain: Social Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,550