The status and influencing factors of pressure on women of childbearing age to have a child again: A cross-sectional study in China.
BACKGROUND Persistently low fertility and rapid population aging have increased concern regarding subsequent childbearing in China. Although fertility intentions have been widely examined, the multidimensional pressure experienced by parous women when considering another child remains insufficiently understood. METHODS An online cross-sectional survey was conducted from January to June 2025 among 2097 parous women aged 18-49 years across 21 provinces and four municipalities in China. Subsequent fertility pressure was assessed using a validated 24-item scale. Guided by Becker's quantity-quality trade-off theory and the socio-ecological framework, hierarchical multiple linear regression was conducted by entering variables in four blocks: demographic characteristics, family and caregiving factors, socioeconomic and structural factors, and psychological and cultural factors. RESULTS The mean subsequent fertility pressure score was 118.17 ± 23.41, indicating that women experienced pressure across multiple economic, occupational, health, childcare, child-development, and family-relationship domains. Higher fertility pressure was associated with poorer self-rated health, having more existing children, maternal primary caregiving, the absence of affordable childcare, lower personal and household income, smaller housing area, lower self-perceived social status, lower subjective wellbeing, more frequent Internet use, a lower ideal number of children, and weaker endorsement of lineage continuation. Compared with government-provided childcare, market-based childcare was also associated with higher pressure. Greater partner participation in housework and having only daughters rather than only sons were associated with lower pressure. The final model explained 26.3% of the variance in fertility pressure (Adjusted R2 = 0.253). CONCLUSIONS Subsequent fertility pressure among parous women is a socially embedded experience shaped by physical capacity, cumulative caregiving demands, gendered household labor, material security, childcare provision, psychological resources, and fertility values. Policies should prioritize stable and affordable public childcare, a sustained redistribution of unpaid care through father-specific leave and paternal involvement, targeted economic and housing assistance, maternal health and mental health support, and protection of women's reproductive autonomy.