A quantitative content analysis of Chinese policies on fertility-friendly hospital development: a three-dimensional framework

Background This study examined the characteristics of Chinese policy documents on fertility-friendly hospital development using a policy-tool lens, identified patterns of policy emphasis and areas receiving comparatively less attention, and provided evidence for further policy improvement. Methods A three-dimensional analytical framework encompassing policy tools, stakeholders, and policy objectives was developed and applied to a quantitative content analysis of 52 national- and provincial-level policy documents on fertility-friendly hospital development issued between April 2016 and February 2026. Results The distribution of policy tools was uneven, with supply-side and environmental tools accounting for 53.29 and 34.69% of policy-tool coded references, respectively, whereas demand-side tools accounted for 12.02%. Maternity care institutions were the most frequently represented stakeholder group, accounting for 42.12% of stakeholder-related coded references. Among the policy objectives, the promotion of institutional friendliness and the establishment of supportive mechanisms received the greatest emphasis, accounting for 36.44% of policy-objective coded references. Conclusion The included policies were characterized by greater emphasis on supply-side and environmental tools, maternity care institutions, and selected policy objectives, whereas demand-side tools and broader stakeholder participation received comparatively less attention. Future policy development may consider broadening the use of demand-side tools, increasing explicit policy attention to primary healthcare institutions and social organizations, and promoting broader stakeholder participation. Such changes may support a more comprehensive, multidimensional, and collaborative governance framework spanning the continuum of care.