Regional disparities and factors associated with third-child fertility intentions among reproductive-age population in Eastern China post the three-child policy: a systematic review and meta-analysis

Background and purpose Fertility decline and population aging have become major demographic challenges in China. This systematic review and meta-analysis aimed to estimate the prevalence of third-child fertility intention (TCFI) among reproductive-age populations and further childbearing intention (FCI) among participants with two children in Eastern China, and to examine associated factors. Methods Web of Science, Embase, PubMed, Cochrane Library, CNKI, VIP, CBM, and Wanfang were searched for cross-sectional studies published from 31 May 2021 to 23 August 2026. Two reviewers independently performed study selection, data extraction, and quality assessment. Random-effects meta-analyses were used to estimate pooled proportions and crude odds ratios (ORs) with 95% confidence intervals (CIs). Results Eighteen studies involving 31,636 participants were included. The pooled prevalence of TCFI was 6.6% (95% CI: 4.7%−9.0%), and that of FCI was 10.2% (95% CI: 7.4%−13.8%). Subgroup analyses by geographical region, population characteristics, and sample size did not identify a clear source of heterogeneity. Older age, education at or below high school level, rural residence, being married, and lack of pension insurance were associated with higher TCFI, whereas public official status was associated with lower TCFI. Medical insurance was not significantly associated with TCFI. For FCI, no statistically significant associations were identified for age, sex composition of the existing two children, or public official status; however, only a limited number of studies contributed to these analyses. Conclusion TCFI and FCI remained low in Eastern China after implementation of the three-child policy. Several demographic and socioeconomic factors were associated with TCFI, whereas evidence regarding factors associated with FCI remained limited and inconclusive. Given the substantial heterogeneity and limited evidence for FCI-related factors, these findings should be interpreted with caution. Registry https://inplasy.com/ , INPLASY(INPLASY202650095).