• Jiang Xiu Xiu, Wu Rui Jin, Liu Yan Min, Pan Min Zhu, Xu Kai Hong, and Lin Jun.
• Department of Gynecology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou City, Zhejiang Province, China.
• Lancet. 2016 Oct 1; 388 Suppl 1: S1.

BackgroundWith the end of 35 years of the one-child policy in China, the second-child policy presents a challenge for maternity hospitals. We aimed to inform configuration of medical resources by investigating willingness to have a second child in women with risk factors for adverse pregnancy outcomes.MethodsWe did a cross-sectional study in two hospitals in Zhejiang province, China. We surveyed women aged 30-45 years with gynecological disease (6000 in a university hospital and 6000 in a county hospital) by questionnaire, between January and April, 2016. The survey included questions about age, location, educational degree, occupation, physical health, family economic situation, current marital status, composition of women's parents' family, influence of second child on family and work, and childbearing history. Patients with malignant gynecological disease were excluded. Written informed consent was obtained, and the study was approved by the hospitals' institutional review boards.FindingsFor university hospital patients, willingness to have a second child was more closely associated with age (OR 1·005, 95% CI 0·105-3·843, p=0·005) and location (1·041, 0·077-10·37, p=0·043) than in county hospital patients. University hospital patients, with mean age 33·93 years (SD 3·77), were more likely to have two children than county hospital patients, with mean age 34·57 years (SD 4·20; OR 5·85, 95% CI 1·20-28·51, p=0·014). Patients living in rural areas were more likely to be willing to have two children than those living in cities (57·61%, 1060 of 1840 vs 45·91%, 1910 of 4160; OR 1·028, 95% CI 0·51-4·38, p=0·008). For county hospital patients, willingness to have a second child was more closely associated with parents' family composition (OR 1·082, 95% CI 0·02-7·05, p=0·05) than for university hospital patients. In the university hospital, women from families in which both husband and wife were only children, or in which the woman was an only child, were more likely to have two children than from families in which both husband and wife were not only children (64·57%, 1270 of 1966 vs 35·43%, 1670 of 4714, OR 1·02, 95% CI 0·04-10·22, p=0·017.InterpretationRisk factors for adverse pregnancy outcomes are not associated with a reduced willingness to have a second child. In addition to strengthening the capacity and quality of maternal health delivered by hospitals, the Chinese government should increase training and financial support for hospitals to cope with adverse pregnancy outcomes.FundingNone.Copyright © 2016 Elsevier Ltd. All rights reserved.

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