{
  "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.Trial registration number ChiCTR2200061046.",
  "authors": [
    {
      "affiliations": [
        "Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Jing Yu"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Yangyang Gao"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Taoran Liu"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Xinyang Ma"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong",
        "Department of Gynecology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China"
      ],
      "name": "Cailin Wu"
    },
    {
      "affiliations": [
        "Global Society and Sustainability Lab, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, Hong Kong",
        "Fairbank Center for Chinese Studies, Harvard University, Cambridge, Massachusetts, USA"
      ],
      "name": "Chun-Kai Leung"
    },
    {
      "affiliations": [
        "Institute for Human Development and Potential (IHDP), Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore",
        "Bioinformatics Institute (BII), Agency for Science, Technology and Research (A*STAR), Singapore, Republic of Singapore",
        "Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore"
      ],
      "name": "Jian Huang"
    },
    {
      "affiliations": [
        "Department of Obstetrics and Gynecology, Queens Hospital Center, NYC Health + Hospitals, Jamaica, New York, USA"
      ],
      "name": "Babatunde O Akinwunmi"
    },
    {
      "affiliations": [
        "Institute for Six-Sector Economy, Fudan University, Shanghai, China",
        "Reproductive Medicine Center, Shenzhen Luohu District People's Hospital, Shenzhen, Guangdong, China"
      ],
      "name": "Shaolin Liang"
    },
    {
      "affiliations": [
        "College of Education for the Future, Beijing Normal University, Beijing, China"
      ],
      "name": "Wenshan Fu"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Xinchang Liu"
    },
    {
      "affiliations": [
        "School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong"
      ],
      "name": "Casper J P Zhang"
    },
    {
      "affiliations": [
        "Department of Nursing, the Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, Zhejiang, China"
      ],
      "name": "Yibo Wu"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong",
        "School of Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia"
      ],
      "name": "Ginenus Fekadu"
    },
    {
      "affiliations": [
        "Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Science, City University of Hong Kong, Hong Kong, Hong Kong",
        "Institute of Global Governance and Innovation for a Shared Future, City University of Hong Kong, Hong Kong, Hong Kong",
        "City University of Hong Kong Shenzhen Research Institute, Shenzhen, Guangdong, China"
      ],
      "name": "Wai-Kit Ming"
    }
  ],
  "title": "Association between epidural analgesia experience and future fertility intention in China: a national cross-sectional study",
  "uid": "b4b3f05c-1272-55ef-b020-696bcd7fac42"
}