Association between epidural analgesia experience and future fertility intention in China: a national cross-sectional study.

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.