Health insurance integration and fertility intentions among migrant populations in China: evidence from urban–rural medical reform
Abstract Background China’s integration of urban and rural medical insurance (IURMI) aims to promote equitable healthcare access for migrant populations. While social insurance is often expected to ease economic constraints and support childbearing, little is known about how IURMI influences fertili...
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BMC
2025-08-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-13257-9 |
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| author | Haowen Jia |
| author_facet | Haowen Jia |
| author_sort | Haowen Jia |
| collection | DOAJ |
| description | Abstract Background China’s integration of urban and rural medical insurance (IURMI) aims to promote equitable healthcare access for migrant populations. While social insurance is often expected to ease economic constraints and support childbearing, little is known about how IURMI influences fertility intentions among migrant women. This study examines whether expanded health coverage through IURMI affects reproductive decision-making and explores underlying mechanisms. Methods This study uses data from the 2018 China Migrants Dynamic Survey (CMDS), focusing on 53,837 migrant women aged 17 to 49. To ensure robust causal inference, it applies propensity score matching (PSM), double/debiased machine learning (DML), and instrumental variable (IV) estimation. The models control for a wide range of individual, household, and regional characteristics and include subgroup analyses to assess heterogeneity in policy effects. Results The findings show a significant negative association between IURMI and fertility intentions. The effect is stronger among women who are employed and intend to stay in cities. Rather than discouraging childbirth directly, IURMI appears to support more deliberate and long-term life planning, leading some women to postpone or reduce childbearing as they prioritize career and settlement goals. Conclusions The results highlight how institutional support through health insurance can influence fertility decisions by enhancing individuals’ ability to plan for the future. Lower fertility intentions among migrant women may reflect greater control over life trajectories rather than diminished desire for children. These findings emphasize the importance of aligning health policy with the evolving needs and preferences of urban migrant populations. |
| format | Article |
| id | doaj-art-e2ce64730f5e40219328ca37cdbae3c6 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-e2ce64730f5e40219328ca37cdbae3c62025-08-20T03:46:04ZengBMCBMC Health Services Research1472-69632025-08-0125111310.1186/s12913-025-13257-9Health insurance integration and fertility intentions among migrant populations in China: evidence from urban–rural medical reformHaowen Jia0School of Economics, Shandong Technology and Business UniversityAbstract Background China’s integration of urban and rural medical insurance (IURMI) aims to promote equitable healthcare access for migrant populations. While social insurance is often expected to ease economic constraints and support childbearing, little is known about how IURMI influences fertility intentions among migrant women. This study examines whether expanded health coverage through IURMI affects reproductive decision-making and explores underlying mechanisms. Methods This study uses data from the 2018 China Migrants Dynamic Survey (CMDS), focusing on 53,837 migrant women aged 17 to 49. To ensure robust causal inference, it applies propensity score matching (PSM), double/debiased machine learning (DML), and instrumental variable (IV) estimation. The models control for a wide range of individual, household, and regional characteristics and include subgroup analyses to assess heterogeneity in policy effects. Results The findings show a significant negative association between IURMI and fertility intentions. The effect is stronger among women who are employed and intend to stay in cities. Rather than discouraging childbirth directly, IURMI appears to support more deliberate and long-term life planning, leading some women to postpone or reduce childbearing as they prioritize career and settlement goals. Conclusions The results highlight how institutional support through health insurance can influence fertility decisions by enhancing individuals’ ability to plan for the future. Lower fertility intentions among migrant women may reflect greater control over life trajectories rather than diminished desire for children. These findings emphasize the importance of aligning health policy with the evolving needs and preferences of urban migrant populations.https://doi.org/10.1186/s12913-025-13257-9Integration of urban and rural medical insuranceMigrant womenFertility intentionsSocial health insuranceUrban integrationReproductive decision-making |
| spellingShingle | Haowen Jia Health insurance integration and fertility intentions among migrant populations in China: evidence from urban–rural medical reform BMC Health Services Research Integration of urban and rural medical insurance Migrant women Fertility intentions Social health insurance Urban integration Reproductive decision-making |
| title | Health insurance integration and fertility intentions among migrant populations in China: evidence from urban–rural medical reform |
| title_full | Health insurance integration and fertility intentions among migrant populations in China: evidence from urban–rural medical reform |
| title_fullStr | Health insurance integration and fertility intentions among migrant populations in China: evidence from urban–rural medical reform |
| title_full_unstemmed | Health insurance integration and fertility intentions among migrant populations in China: evidence from urban–rural medical reform |
| title_short | Health insurance integration and fertility intentions among migrant populations in China: evidence from urban–rural medical reform |
| title_sort | health insurance integration and fertility intentions among migrant populations in china evidence from urban rural medical reform |
| topic | Integration of urban and rural medical insurance Migrant women Fertility intentions Social health insurance Urban integration Reproductive decision-making |
| url | https://doi.org/10.1186/s12913-025-13257-9 |
| work_keys_str_mv | AT haowenjia healthinsuranceintegrationandfertilityintentionsamongmigrantpopulationsinchinaevidencefromurbanruralmedicalreform |