Childbearing in the Time of COVID-19: A Cross-Sectional Exploration of the Determinants of Childbearing and Childbearing Intention Among Chinese Hong Kong Adults

Background and Purpose: Hong Kong has one of the lowest fertility rates worldwide. Coupled with the decline in overall fertility was a general delay in childbearing, with more women choosing to have children in their mid- to late-thirties. Recently, the low fertility intention may have been further exacerbated by the rise of the COVID-19 pandemic, causing couples to delay or scrape marriage and childbearing plans. Such macro-level sociohistorical event as the COVID-19 pandemic warrants a renewed analysis of the factors that shape people’s childbearing decisions upon which subsequent family policies could be based. The objective of this study is therefore to present an overview of the determinants of childbearing and childbearing intention among Hong Kong adults amid the COVID-19 pandemic.

Methods: This is a cross-sectional study investigating Hong Kong adults’ reproductive intentions, attitudes, knowledge and fertility health risks. All Chinese adults currently residing in Hong Kong were eligible to participate. Participants were recruited through social media platforms and community networks. The final sample size is 675 (mean age = 30, SD = 6.7). Respondents rated on a five-point scale the extent to which a list of determinants were important in childbearing decision-making, and indicted the desire to have children. ANCOVAs were conducted to examine gender and income group differences on the determinants of childbearing; logistic regression was conducted to explore the relation between these determinants and reported childbearing intention.

Results: Overall, women took a wider array of factors into consideration than did men. Whereas the importance of female age on reproductive decisions was acknowledged by both women (p<.001) and men (p=.02), women gave consistently higher ratings across a range of interpersonal (i.e. partner’s education), community (i.e. financial stability, living environment), and systems-level factors (i.e. economic stability, political stability and COVID-19) in relation to childbearing decision-making. There was no important difference between income groups. While controlling for participant demographics, logistic regression analyses revealed that importance of COVID-19 (OR=1.24, p=.02), one’s age (OR=2.03, p<.001), having a stable partner (OR=1.65, p<.001), expectation of family members (OR=1.53, p=.02) and peer parenthood status (OR=1.90, p<.001) were positively associated with the intention to have children, whereas importance of financial stability (OR=.55, p=.02) and political stability (OR=.65, p=.01) were negatively associated with the intention to have children.

Conclusions and Implications: Consistent with an ecological perspective of parenthood, the present findings describe an interplay of intrapersonal, interpersonal, community and systems factors in the shaping of a person’s reproductive intentions. Our findings encourage researchers and policymakers to be deliberate in tackling the fundamental issues that deter people from having children, including work-family conflict, high costs of living, unaffordable housing and at this juncture, the COVID-19 pandemic. It is imperative that, through effective family policies, individuals find parenthood compatible with the ordinary way of living in face of important sociohistorical transitions. Our findings are also useful for clinicians working to assist couples and individuals in making parenthood decisions by shedding light on the preconditions for parenthood and the gender differences that exist herein.