The Impact of Infant and Toddler Care Services on the Reproductive Intentions of Women of Childbearing Age in the Context of Low Fertility in China: A Cross-Sectional Survey Study

Objective: Infant and toddler care services are crucial fertility support measures in the context of China's low birthrate and aging population. This study aims to understand the current family care needs under existing care policies and their impact on families' intentions to have additional children, providing scientific evidence for improving social population development and care policies. Methods: A survey and interview method was employed, which included 9,699 parents of infants and toddlers from September to December 2022, along with interviews of individuals involved in infant and toddler care. Results: There is a significant regional disparity in the number of registered infant and toddler care institutions in China, with more in the eastern regions. Among the survey respondents, 54.81% of families used infant and toddler care services. Parental education level, monthly household income per capita, parental age, and employment interruptions in the family were significantly associated with the use of care services (P < 0.01). Grandparents were the primary caregivers in 54.87% of families, with most families spending between 2000–3000 yuan on childcare (45.8%). Regarding care needs, families with infants and toddlers preferred full-day care services (71.08%), favored public (61.46%) and workplace-based care (22.24%), and preferred institutions close to home (85.74%). They also preferred care costs to be between 1001–2000 yuan (51.81%), considered the optimal age for entering care to be 2–3 years (80.30%), and preferred care by professional caregivers (70.68%). Logistic regression analysis indicated that a monthly household income per capita between 3000–5000 yuan (P < 0.05), one-year maternity leave (P < 0.05), and concerns about the management, distance, fees, food, and early education in care institutions (P < 0.01) were factors influencing families' willingness to have additional children. Interviews revealed that there are few affordable care institutions, high operating costs, inconsistent industry standards, and issues with caregiver qualifications. Conclusion: China's infant and toddler care policy has deficiencies, with grandparental care being predominant. There is a significant demand for care services, and there is an urgent need to improve the quality and quantity of care institutions. Employment pressure, economic burden, and care service development affect families' reproductive intentions.