ArticleThe Lancet regional health. Western Pacific2025
Changing patterns of education, marriage and fertility in Chinese adolescents: a systematic synthesis of national and subnational population data from 1990 to 2020.
Article in The Lancet regional health. Western Pacific, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Secondary education, and early marriage and childbirth are major determinants of health and wellbeing. We aimed to describe the long-term trends and inequalities of these three indicators in Chinese adolescents over three decades of dramatic social and economic change. Methods: Using data from Chinese population censuses and 1% population sample surveys from 1990 to 2020 (the most recent survey), we calculated the senior secondary school participation rate in 20-24-year-olds, the ever-married rate in 15-19-year-olds, and the age-specific fertility rate in 15-19 year-old females, by urban-rural location and province. Findings: In urban areas, the secondary school participation rate substantially increased, from 34.7% in 1990 to 82.4% in 2020 for females and from 38.7% to 77.0% for males. The participation rate in rural areas also greatly increased, from 5.0% in 1990 to 55.7% in 2020 for females and from 9.1% to 51.0% for males, but remained markedly lower than in urban areas at all time points. The ever-married rate decreased dramatically from 1990 to 2005, rebounded between 2005 and 2015, and then dropped so that the rate in 2020 was at a level comparable to that in 2005 (0.7% [95% CI 0.7-0.7] for urban females, 2.2% [2.1-2.2] for rural females, 0.2% [0.2-0.2] for urban males, and 0.5% [0.5-0.5] for rural males). In urban areas, the fertility rate decreased from 10.1 per 1000 in 1990 to 2.4 (2.3-2.4) per 1000 in 2000, but then largely stabilised between 2000 and 2020. For rural adolescents, the fertility rate also decreased dramatically from 25.9 per 1000 in 1990 to 8.5 (8.2-8.8) per 1000 in 2005. The fertility rate rebounded to 15.4 (14.9-15.9) per 1000 in 2015 and decreased to 12.5 (12.3-12.7) in 2020 in rural areas. These three indicators greatly varied by province in 2020, with more negative patterns in western provinces. Interpretation: China has seen dramatic changes in adolescent education, and early marriage and fertility over the past three decades but large inequities persist between urban-rural areas and by province. Government investments are needed to promote education in rural areas and western regions to promote more equitable health, development and wellbeing in Chinese adolescents. Funding: National Nature Science Foundation of China.
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