Labor pain relief and women's evaluations of childbearing: Evidence from a conjoint experiment in China.

As governments respond to fertility decline with pronatalist policies centered on economic and childcare support, childbirth itself remains undertheorized as an embodied and gendered experience. This study contributes to fertility research and maternal health scholarship by documenting unmet demand for labor pain relief in China and examining how access to pain management shapes women's evaluations of whether conditions are favorable for having a child. We draw on an original study of 2866 women of reproductive age that combines a conjoint experiment with survey questions on childbirth experiences and attitudes. To our knowledge, this is the first large-sample study to examine labor pain relief and evaluations of childbearing conditions together. We estimate the causal effects of epidural access and family support for its use alongside commonly studied factors such as household income and childcare support. Results show substantial unmet demand: most respondents regard childbirth pain as important for fertility decision-making, yet nearly half of those with recent vaginal delivery experience did not receive epidural analgesia during labor. Experimental results further suggest that, compared with sometimes-available access, always-available epidural access improves these evaluations by approximately 70% of the effect of receiving childcare support, while family support for epidural use increases these evaluations by an amount comparable to that of moving from sufficient to comfortable household income. These findings underscore the importance of integrating maternal health and childbirth experiences into theories of fertility decision-making and reproductive policy debates.