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Abstract

The present study investigated the moderating role of gender in the relationship between parenting costs and second-child fertility anxiety. This secondary data analysis relied on information from 1,834 respondents of childbearing age (20–45) from Jilin province in China who were selected through multilevel cluster sampling in 2016. The final sample size of this study was 542 adults who had only one child and were uncertain about whether to have a second child. The proposed hypothesis was examined by hierarchical multiple regression. The results showed that gender had no moderating effect in the relationship of direct parenting costs and second-child fertility anxiety; the association between direct parenting costs and second-child fertility anxiety was significant in both male and female groups. However, gender had a moderating role in the relationship between indirect parenting costs and second-child fertility anxiety. Indirect parenting costs related to occupation had a significant effect on second-child fertility anxiety among men, whereas indirect parenting costs involving entertainment time and space had a significant effect on second-child fertility anxiety among women.

Keywords

adults of childbearing age parenting costs second-child fertility anxiety

Introduction

Family planning policy implemented in the late 1970s and early 1980s controlled China’s population growth effectively; however, it also led to population problems, such as an aging population, imbalance of sex ratio at birth, and labor shortages. To relieve the stress caused by these problems, in 2016, the Chinese government implemented the two-child policy. However, the fertility behavior of adults of childbearing age did not seem to achieve the desired effect. Fertility intentions directly reflect the concept and culture of fertility, and fertility behavior reflects the reality of adults of childbearing age (Bachrach & Morgan, 2013; Rong & Baochang, 2014). Age, generation, education level, occupation, women’s social and family status, fertility concept, family structure, cost of raising children, and comparison of benefits and costs all influence fertility intentions and fertility behavior (Feng & Li, 2016; Huang, 2015; B. Li & Xiang, 2010; Park, 2009; J. Wang et al., 2017; Yang et al., 2014; Y. Zhang et al., 2014; Zheng, 2014). Fertility intentions and fertility behavior are not the same concept (W. Chen & Jin, 2011; J. Wang & Wang, 2016). Studies have shown serious deviation between fertility intentions and fertility behavior among couples of childbearing age (W. Chen & Jin, 2011; Song & Chen, 2010; J. Wang & Wang, 2016). Affected by China’s traditional culture, which includes fertility concepts such as “The more sons, the more happiness”; “The son preference”; and “Bring up sons to provide for oneself in old age” (Tian & Chen, 2006), at present, most adults of childbearing age in China are still willing to have two children, but the reality is that most families decide not to have a second child (Feng & Li, 2016; Zheng, 2014). The deviation between fertility intentions and behavior can cause anxiety among adults of childbearing age regarding whether to have a second child.

Defining Second-Child Fertility Anxiety

Second-child fertility anxiety is a kind of “social suspense,” referring to psychological nervousness when facing the decision of whether to have a second child (J. Zhang & Tian, 2019). Social suspense refers to these psychological states among individuals facing indeterminacy factors in their social environment (Erich, 2000; Gay, 1984; Harold, 2008; Hunt, 1999). After the two-child policy was implemented, many couples of childbearing age who were not allowed to have a second child now had this opportunity. However, limited by factors (such as economic limitations, lack of child care resources, and reproductive health problems), most couples of childbearing age have not chosen to have a second child (Zhou & Zhou, 2001). At the same time, seeing friends having a second child or experiencing the stress of different fertility intentions between parents or spouses, adults who are unable or have no intention to have a second child may face contradictions with their families (J. Wang & Wang, 2016; Wu & Feng, 2020). In the decision-making process regarding having a second child, when a contradiction between subjective fertility intentions of having a second child and objective obstacles of reality regarding fertility behavior appears, couples of childbearing age often experience anxiety, referred to as second-child fertility anxiety (J. Zhang & Tian, 2019). This anxiety typically manifests in two situations: Adults of childbearing age want to have a second child but are limited by reality (including economic, occupation, or child care conditions) or they do not want to have a second child, yet their parents or spouse want them to have a second child (Y. Mu & Yuan, 2018; Wu & Feng, 2020; J. Zhang & Tian, 2019). Both situations can produce anxiety among adults of childbearing age. The essential factor of second-child fertility anxiety is parenting costs. Under this premise, analysis of how parenting costs affect second-child fertility anxiety is necessary.

Parenting Costs

Parenting costs refer to the expenditures (visible and invisible) related to parenting a child (Leibenstein, 1974; G. Mu, 1993; J. Wang et al., 2017). Harvey Leibenstein (1974, 1975) used economic theory to construct a children’s cost-utility model. He divided parenting costs into direct and indirect costs. Direct costs include the expenses of education, medical care, entertainment, and other activities paid by parents while raising a child. Indirect costs involve the educational opportunities and work income that parents lose due to raising a child. The child’s utility can be divided into hedonic utility, economic utility, (pension) insurance utility, the utility of resisting family economic risk, and the utility of maintaining family status or expanding family size. He assumed that couples are rational economic people, and thus, when they make fertility decisions, once the expected parenting costs are greater than the expected utility, parents may decide not to have one more child. Gary Becker (1960) proposed the children quantity–quality substitution theory. He argued that children are a time-intensive good, requiring parents to spend a lot of time to accompany and cultivate them. At the same time, in recent years, women’s education levels and public work participation rate have increased, the time value of parents have increased greatly, and parenting a child requires more opportunity costs. The development of society also requires high-quality labor, and thus, the standard of quality for children is much higher than before. Therefore, when making fertility decisions, the need for quality children among couples of childbearing age reduces the need for quantity regarding children. In addition, parenting costs also include the negative impact on the relationship between couples and development among individuals of childbearing age, such as reduction in the time couples spend together or communicate with each other, conflicts produced by children, lack of freedom or flexibility to go out, and limitations in career development (Kohler et al., 2005; Myrskyla & Margolis, 2014; Presser, 2001).

Parenting Costs and Fertility Anxiety

Some scholars concluded that parenting costs are the most important factor influencing second-child fertility intentions (Tan, 2015; J. Wang et al., 2017; Zheng, 2009). Different from Western countries, China’s traditional fertility culture has a strong preference for sons, especially among older adults (Feng & Li, 2016; Hou et al., 2015; J. Li, 2009; Shi et al., 2017). In China, fertility is not only a matter for couples of childbearing age—It is an affair that involves all family members (Rong & Baochang, 2014). In most families, the fertility decisions of couples of childbearing age are affected by their parents’ fertility desires (He & Yu, 2017; Wu & Feng, 2020). In modern China, parenting costs and care burden are higher than before. Furthermore, the rate of women in the workforce has increased, and they have less time to fulfill traditional family caregiving duties (W. Chen & Jin, 2011; Mao & Luo, 2013). Under the dual burden of economic and family stress, many adults of childbearing age suppress their fertility intentions (Feng & Li, 2016; Y. Mu & Yuan, 2018; Song & Chen, 2010). Thus, deviation between fertility intentions and fertility behavior has appeared (W. Chen & Jin, 2011).

Role of Gender Between Parenting Costs and Fertility Anxiety

For modern women, especially those in the workforce, more factors influence their fertility behavior, including increased education level, changes in social and family status, increased labor participation rate, and transformation of their attitudes toward fertility (Y. Chen, 2017; Myrskyla & Margolis, 2014; Sanchez & Thomson, 1997; Yu, 2014; X. Zhang, 2017). Work–family conflict theory argues that individuals have great difficulties in dealing with family responsibilities and job needs (Brines, 1994; Greenstein, 1996; Huang, 2015). Because women are the subject of fertility, the indirect costs of work and family conflicts are mainly borne by women (J. Zhang & Tian, 2019). Therefore, parenting costs probably have different effects on second-child fertility anxiety between men and women.

Most existing research has examined the relationship between parenting costs and fertility behavior through a single perspective. Some research tested the relationship between parenting costs and fertility behavior through an economic perspective, finding that the economic factor is the most important influence on fertility behavior and one that leads many families to avoid having a second child due to the increasing parenting costs, including direct and indirect costs (J. Wang et al., 2017; Z. Wang & Liu, 2017). Other studies tested women’s fertility stress caused by work–family conflict through the perspective of women’s increased education level or labor participation rate (Yu, 2014). The popularization of gender equality could accelerate the transformation of fertility values (Y. Chen, 2017; Shi et al., 2017). In contrast to men, the popularization of gender equality among women has been much more rapid, so the transformation of men’s fertility values is slower than women’s (Y. Chen, 2017; Liu et al., 2015; P. Wang, 2015). In other words, the transformation of men’s and women’s fertility values are out of sync. Thus, when making fertility decisions, not only women but also men often experience much more stress related to these conflicts, leading to different perspectives regarding fertility between spouses and between parents and couples of childbearing age. Thus, regardless of gender, making a second-child fertility decision is likely to produce anxiety for parents. However, very little research has studied fertility anxiety of adults of childbearing age. Also, limited research has studied the moderating role of gender. In this article, we use the gender moderation model to test the moderating role of gender in the relationship between parenting costs and second-child fertility anxiety.

Method

Sampling

This study is a secondary data analysis. The data were derived from a survey titled “The Influence of the ‘Universal Two-Child Policy’ on Female Fertility Behavior,” which was conducted by the Institute of Gender and Culture at Changchun Normal University in October 2016. The survey covered eight cities in Jilin province. The economic development of Jilin province is dependent on agriculture, and the level of economic development in Jilin province is relatively low. Thus, the per capita income of people living in Jilin province is lower than those in most other developed provinces in China. However, like developed areas of China, couples in Jilin province desire to cultivate high-quality children, and thus, the parenting costs in Jilin province are still at relatively high levels. At the same time, most residents of Jilin province are not original residents of the area; many migrated from central China (including Henan, Shandong, and Anhui provinces, among others) during times of famine. Thus, traditional fertility culture may not be the primary influencing factor for adults of childbearing age in Jilin province, although it remains the main fertility concept of the previous generation (Hou & Yu, 2015). Therefore, the discordance of fertility concepts between older and newer generations may lead to more conflicts. Accordingly, Jilin province is an ideal place to test the relationship between parenting costs and second-child fertility anxiety. The questionnaire was completed by participants in Mandarin, and all variables and measures were translated from this version. We performed a back translation to ensure no significant differences between the two versions. Ethics approval was obtained from the Institute of Gender and Culture at Changchun Normal University; research data are available upon request.

The sample size was allocated according to the relative population size of the surveyed area, and multilevel cluster sampling was used. The respondents were 20 to 45 years old as of October 2016, married, and had at least one child (regardless of gender); we choose one member from each family. Surveyors distributed 1,920 questionnaires, and 1,834 valid questionnaires were returned; thus, the rate of valid questionnaires was more than 80%. The survey assessed the basic situation of the respondents, fertility intentions, and subjective factors affecting the decision to have a second child, and the influence of the “universal two-child” policy on the couple’s work and family balance. One item with four answer options measured fertility intentions: “I want to have a second child,” “I do not want to have a second child,” “I am not sure,” and “I am thinking about it.” Respondents who chose “I want to have a second child” or “I don’t want to have a second child” indicated they had already made their fertility decision, so they would not think too much about the issue of second-child fertility and would have little second-child anxiety. Only respondents who were “not sure” or “thinking about it” would have more concern about having a second child. Therefore, in this article, we focused on participants who chose the answers of “I am not sure” and “I am thinking about it,” and excluded the other respondents. The final sample was 542 people.

Measurements

Dependent variable: Second-child anxiety

First, we selected research participants through responses to the question, “After the ‘universal two-child policy’ was implemented, do you want to have a second child?” As previously described, the answer options were “I want to have a second child,” “I do not want to have a second child,” “I am not sure,” and “I am thinking about it.” Respondents who want or do not want to have a second child have certain intentions about fertility, so it is unlikely that they have second-child fertility anxiety. Respondents who were uncertain were more likely to have second-child fertility anxiety. For respondents who answered “I am not sure” and “I am thinking about it,” we used another item to measure their second-child fertility anxiety: “Imagining that someone else has two children and you do not have the conditions (included economic limitations, lack of child care resources, reproductive health problems, etc.) to have a second child, tell me the degree of anxiety you feel.” Answers were coded 1 to 5, with 1 indicating not too anxious and 5 indicating very anxious.

Independent variable: Parenting costs

Parenting costs can be divided into direct and indirect costs. We used a question to measure direct costs: “How much did you spend on your child per month in the last year?” Answer options were divided into three categories (0 = less than 2,000 yuan; 1 = 2,001–4,000 yuan; 2 = more than 4,000 yuan). We used two questions to measure indirect costs: “How much do you think having a second child will affect your career?” “How much do you think that having a second child will reduce your entertainment time and space?” We used a 5-point Likert-type scale to measure the responses (1 = very little, 2 = a little, 3 = medium, 4 = much, 5 = very much), and higher scores indicated greater indirect costs.

Moderating variable: Gender

We coded gender as a dichotomous variable. Male was coded as 0 and female was coded as 1.

Control variables: Demographics

Control variables were age, education level, household registration, family per capita income, and occupation type. Age was calculated according to year of birth. Education level was divided into four categories: “primary school and below,” “junior high school,” “high school,” and “college and above.” We coded them from 1 to 4, respectively. Household registration was divided into “urban” (coded as 1) and “rural” (coded as 2). Family per capita income was divided into five levels coded 1 to 5, respectively, “less than 1,000 yuan,” “1,001–2,000 yuan,” “2,001–3,000 yuan,” “3,001–5,000 yuan,” and “more than 5,000 yuan.” Occupation type was recoded as a dichotomous variable, indicating “in-system work” including government civil, institutional, and state-owned enterprise workers (coded as 1) or “out-system work” including employees of foreign and private companies, farmers, and freelancers (coded as 2). In addition, due to traditional fertility culture in China, most couples of childbearing age have a gender preference for their children. To address the effect of gender preference, we added this variable to our model as a control variable, using gender of the first-born child (1 = male, 2 = female).

Data Analysis

In this study, multiple-group regression was used to construct simultaneous models to test group differences in the relationship between parenting costs and second-child fertility anxiety. Gender was used as a moderator. Maximum likelihood estimator was the default estimator. SPSS 22.0 was used. First, we made a primary model with control variables. Second, we added independent variables to the model to test their contribution. Third, we tested the moderating role of gender in the relationship between the dependent variable and independent variables. In the final step, we tested the effects of independent variables on the dependent variable in male and female groups separately.

Results

Descriptive Statistics

First, we performed a descriptive analysis of all variables (Table 1), including distribution frequency for categorical variables and mean and standard deviation for continuable variables. The minimum score of the variable of second-child fertility anxiety was 1 and the maximum score was 5, with a mean of 2.00 (SD = 1.02). The gender distribution was equitable, with 272 men and 270 women. The minimum age of the respondents was 20 and the maximum age was 45, with a mean of 34.97 (SD = 5.03). Urban and rural household registration accounted for 54.1% and 45.9% of the sample, respectively. Education level was mainly concentrated in high school, accounting for 41.9% of the sample. Family per capita income was mainly from 3,001 to 5,000 yuan, accounting for 28.0% of the sample. The percentage of people employed in in-system work accounted for 42.1% of the sample. The first-child gender distribution was relatively even, with the percentage of boys and girls being 49.5% and 50.5%, respectively. Direct parenting costs ranged from 1 to 5, and the mean was 2.83 (SD = 0.99). Indirect costs related to occupation ranged from 1 to 5, with a mean of 1.67 (SD = 1.40), and indirect costs involving entertainment time and space costs ranged from 1 to 5, with a mean of 3.05 (SD = 1.28).

Table 1.

Sample Characteristics (N = 542).

Variable	n (%)	M (SD)
Fertility anxiety		2.00 (1.02)
Gender
Male	272 (50.2)
Female	270 (49.8)
Age		34.97 (5.03)
Household registration
Urban	293 (54.1)
Rural	249 (45.9)
Education level
Primary school	62 (11.4)
Junior school	176 (32.5)
High school	227 (41.9)
Collage and above	77 (14.2)
Income (Yuan)
<1,000	89 (16.4)
1,001–2,000	83 (15.3)
2,001–3,000	112 (20.7)
3,001–5,000	152 (28.0)
>5,001	106 (19.6)
First child gender
Male	273 (50.5)
Female	268 (49.5)
Occupation
In-system	228 (42.1)
Out-system	314 (57.9)
Direct costs		2.83 (0.99)
Occupation costs	1.85 (0.99)	1.67 (1.40)
Time and space costs		3.05 (1.28)

We conducted an independent t test to examine differences in sociodemographic characteristics and parenting costs between the two gender groups. There were no significant differences in all independent variables between the two groups. However, the dependent variable, second-child fertility anxiety, differed significantly between the two groups.

Model Results

First, we tested the collinearity of the independent variables. Variance inflation factor values of all variables were less than 10 and the tolerance values of all variables were greater than 0.2, indicating no collinearity between variables. The Durbin–Watson estimate was 1.869 and the model explained 22.3% of second-child fertility anxiety. A three-step analysis procedure was implemented (Table 2). In the first step, we constructed a basic model with control variables, and the model explained 12.8% of second-child fertility anxiety. In the second step, we added independent variables of direct and indirect parenting costs, and the model fit increased greatly (from 12.8% to 20.3%). This means that the independent variables contributed significantly to the model. Direct costs had the greatest impact on second-child fertility anxiety (β = .255, t = 6.379, p < .01). Indirect costs related to occupation had a less significant effect on second-child fertility anxiety in the model (β = .113, t = 2.279, p < .05), whereas indirect costs related to entertainment time and space had no significant effect on second-child fertility anxiety in the model (β = .041, t = 1.006, p > .05). In the third step, we tested the moderating role of gender in the relationship between parenting costs and second-child fertility anxiety. We found that gender had moderating effects on both indirect costs related to occupation and entertainment time and space (β = −.183, t = −2.514, p < .05; β = .291, t = 2.577, p < .05, respectively), whereas gender had no moderating effect on direct costs (β = .221, t = 1.778, p > .05).

Table 2.

Multiple Regression of Parenting Cost and Second-Child Fertility Anxiety.

Variables	1				2				3
Variables	B	SE	β	P value	B	SE	β	P value	B	SE	β	P value
(constant)	0.352	0.470		0.455	−0.679	0.480		0.158	−0.376	0.494		0.446
Age	0.030	0.009	0.147	0.001	0.025	0.009	0.124	0.003	0.027	0.009	0.133	0.002
Gender	0.263	0.083	0.129	0.002	0.212	0.080	0.104	0.008	−0.444	0.315	−0.218	0.159
Household registration	−0.288	0.099	−0.141	0.004	−0.196	0.097	−0.096	0.044	−0.199	0.096	−0.097	0.039
Education level	0.043	0.060	0.037	0.472	0.052	0.059	0.045	0.376	0.050	0.059	0.043	0.394
Per capita income	0.091	0.038	0.126	0.016	0.074	0.036	0.103	0.042	0.074	0.036	0.103	0.040
Occupation	0.081	0.102	0.039	0.426	0.159	0.107	0.077	0.136	0.180	0.106	0.087	0.090
First child gender	0.250	0.083	0.123	0.003	0.254	0.080	0.124	0.002	0.245	0.079	0.120	0.002
Direct costs					0.262	0.041	0.255	0.000	0.183	0.057	0.178	0.001
Occupation costs					0.083	0.036	0.113	0.023	0.157	0.045	0.216	0.001
Time and space costs					0.033	0.032	0.041	0.315	−0.060	0.048	−0.074	0.211
Direct Costs × Female									0.141	0.080	0.221	0.076
Occupation Costs × Female									−0.143	0.057	−0.183	0.012
Time and Space Costs × Female									0.163	0.063	0.291	0.010

Note. α = 0.05, two-tailed test.

Moderating Effect of Gender

We further measured the moderating role of gender (Figure 1). The model of the male group accounted for 24.5% of second-child fertility anxiety; the model of the female group accounted for 22.3% of second-child fertility anxiety. The model results further validated the moderating role of gender in the relationship between indirect parenting costs and second-child fertility anxiety. Direct costs significantly affected second-child fertility anxiety in both male and female groups, and had a greater effect in the female group (male group: β = .201, t = 3.585, p < .01; female group: β = .278, t = 4.928, p < .01). However, this difference was not significant from a statistical perspective. Indirect costs related to occupation only influenced second-child fertility anxiety in the male group, with no significant effect in the female group (male group: β = .254, t = 3.750, p < .01; female group: β = −.006, t = −.088, p > .05). Conversely, indirect costs involving entertainment time and space influenced second-child fertility anxiety in the female group, with no significant effect in the male group (male group: β = −.072, t = 1.256, p > .05; female group: β = .125, t = 2.186, p < .05).

Figure 1.

The moderating role of gender in the relationship between indirect parenting costs and second-child fertility anxiety.

Discussion

Based on the results of our model, direct parenting costs had the greatest impact on second-child fertility anxiety and had equally important effects on second-child fertility anxiety among men and women of childbearing age. This result verifies cost–benefit theory, indicating that parenting costs are the main factor affecting second-child fertility anxiety in Jilin province. Before the Reform and Opening policy in China in 1978, the planned economy was the main economic approach in China. Most enterprises were state owned and almost all had free kindergartens for their workers’ children, resulting in low parenting costs. However, since the Reform and Opening policy was implemented, along with the rapid social and economic development in China, parenting has become privatized and most costs must be covered by families (Z. Wang & Liu, 2017). According to conclusions from a survey of young people in China, the growth rate in family income was slower than the growth rate of children’s education expenditures (Z. Wang & Liu, 2017). For most families, the pressure of using limited income to raise a second child is unbearable.

Indirect costs related to occupation had a significant effect on second-child fertility anxiety among men, whereas they had no significant effect on second-child fertility anxiety among women. The concept of family responsibility likely affects women and men differently, because taking care of children is the responsibility of women according traditional gender roles, so women are often more prepared for the indirect costs of a second child when they decide to have a second child (Zhao, 2018). Women who care about family responsibilities often want to reduce their work time after they become a mother, whereas men who care about family responsibility want to increase their work time after becoming a father (Sanchez & Thomson, 1997). At the same time, with improving gender equality, men are expected to participate more in housework; yet having a second child will reduce their work time, and they may not be ready for this added responsibility (J. Zhang & Tian, 2019). This situation might produce contradictions between men’s desires (they want to increase their work time) and reality (they should spend more time on housework), producing second-child anxiety for men.

In the overall model, indirect costs related to entertainment time and space had no significant effect on second-child fertility anxiety, because the moderating effect of gender offset the significant effect of these indirect costs. When we added gender as a moderator to the model, the effect of these indirect costs on second-child fertility anxiety was revealed. Indirect costs involving entertainment time and space had a higher impact on women than men. More housework brought on by the second child will likely reduce the leisure time and space of adults of childbearing age. Although the division of housework in families has changed in recent years, women are still the main performers of housework and take on the main responsibility of caring for children (Liu et al., 2015; Yu, 2014; J. Zhang & Tian, 2019). This means that women need to sacrifice more entertainment time and space to have a second child. Because women in the new era want to be liberated from housework, in this situation, when considering whether to have a second child, they often have less fertility intention (Feng & Li, 2016; Liu et al., 2015; Yu, 2014).

There are some limitations to this study. First, cross-sectional data were used. As a result, the causal relationship between the dependent variable and independent variables cannot be clearly determined. However, sufficient theories support the study findings, and the relationship between the dependent variable and independent variables appear statistically significant. Thus, the conclusions of the study are acceptable. Second, this study was conducted in Jilin province, China. Economic, social, and cultural contexts differ in various regions of China, and therefore, the conclusions of this study only represent Jilin province and other regions with similar economic development and population structure. At the same time, fertility anxiety is affected by discordance between generations; however, our sample size was insufficient to test this discordance. In future research, we plan to use longitudinal national data (such as the Chinese General Social Survey) to analyze related issues, such as parenting costs, fertility intentions, and fertility behavior, to further clarify the causal relationship between the dependent variable and independent variables. And we will attempt to test the discordance between generations using the life-course method.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Grant Project of National Social Science Foundation of China “The Comparison of Eastern Asian Rural Vitalization Social Policies” (18ZDA119).

ORCID iD

Jingyue Zhang

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Influence of Parenting Costs on Second-Child Fertility Anxiety Among Adults of Childbearing Age in China: The Moderating Role of Gender

Abstract

Keywords

Introduction

Defining Second-Child Fertility Anxiety

Parenting Costs

Parenting Costs and Fertility Anxiety

Role of Gender Between Parenting Costs and Fertility Anxiety

Method

Sampling

Measurements

Dependent variable: Second-child anxiety

Independent variable: Parenting costs

Moderating variable: Gender

Control variables: Demographics

Data Analysis

Results

Descriptive Statistics

Model Results

Moderating Effect of Gender

Discussion

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

References