Abstract
Objectives
To assess the association between epidural analgesia (EDA) experience and subsequent fertility intention among reproductive-aged individuals with at least one child in China, and to examine whether this relationship varies by region and parity.
Design
This nationwide cross-sectional study was conducted using multistage stratified and quota sampling across 148 cities in mainland China. Data were analysed using descriptive statistics, generalised linear models and multinomial logistic regression (Mlogit).
Setting
Community-based data collection conducted across 148 cities in mainland China between 20 June and 31 August 2022.
Participants
Of 21 872 respondents, 6349 reproductive-aged individuals (females aged 18–49 and males aged 18–65) with at least one child were included after applying standardised data quality criteria.
Primary and secondary outcome measures
The primary outcome was self-rated fertility intention, operationalised as a continuous measure for regression analysis. The main exposure variable was prior experience with EDA during vaginal birth. Secondary analyses explored variations by region and number of children.
Results
EDA experience was positively associated with higher fertility intention (β=0.067, 95% CI 0.007 to 0.126, p=0.028). Female respondents reported lower fertility intention compared with males. Regionally, significant positive associations were observed in the central (relative risk ratio (RRR)=1.433, 95% CI 1.011 to 2.032, p=0.043) and western regions (RRR=1.505, 95% CI 1.070 to 2.117, p=0.019). Among women, EDA use was significantly associated with increased fertility intention in primigravida but not in multigravida participants.
Conclusions
EDA use is positively associated with fertility intention among Chinese reproductive-aged individuals with children. Although this study identifies an association rather than a causal relationship—given the cross-sectional design—it highlights the potential value of improving awareness and access to labour pain management, especially in less developed regions, to better support informed reproductive decision-making and childbirth experiences.
© Author(s) (or their employer(s)) 2026.
To assess the association between epidural analgesia (EDA) experience and subsequent fertility intention among reproductive-aged individuals with at least one child in China, and to examine whether this relationship varies by region and parity.
Design
This nationwide cross-sectional study was conducted using multistage stratified and quota sampling across 148 cities in mainland China. Data were analysed using descriptive statistics, generalised linear models and multinomial logistic regression (Mlogit).
Setting
Community-based data collection conducted across 148 cities in mainland China between 20 June and 31 August 2022.
Participants
Of 21 872 respondents, 6349 reproductive-aged individuals (females aged 18–49 and males aged 18–65) with at least one child were included after applying standardised data quality criteria.
Primary and secondary outcome measures
The primary outcome was self-rated fertility intention, operationalised as a continuous measure for regression analysis. The main exposure variable was prior experience with EDA during vaginal birth. Secondary analyses explored variations by region and number of children.
Results
EDA experience was positively associated with higher fertility intention (β=0.067, 95% CI 0.007 to 0.126, p=0.028). Female respondents reported lower fertility intention compared with males. Regionally, significant positive associations were observed in the central (relative risk ratio (RRR)=1.433, 95% CI 1.011 to 2.032, p=0.043) and western regions (RRR=1.505, 95% CI 1.070 to 2.117, p=0.019). Among women, EDA use was significantly associated with increased fertility intention in primigravida but not in multigravida participants.
Conclusions
EDA use is positively associated with fertility intention among Chinese reproductive-aged individuals with children. Although this study identifies an association rather than a causal relationship—given the cross-sectional design—it highlights the potential value of improving awareness and access to labour pain management, especially in less developed regions, to better support informed reproductive decision-making and childbirth experiences.
© Author(s) (or their employer(s)) 2026.
| Original language | English |
|---|---|
| Article number | e106507 |
| Journal | BMJ Open |
| Volume | 16 |
| Issue number | 3 |
| Online published | 25 Mar 2026 |
| DOIs | |
| Publication status | Published - Mar 2026 |
Funding
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
UN SDGs
This output contributes to the following UN Sustainable Development Goals (SDGs)
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SDG 5 Gender Equality
Publisher's Copyright Statement
- This full text is made available under CC-BY-NC 4.0. https://creativecommons.org/licenses/by-nc/4.0/
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