Patient engagement and feasibility of a QR code-based digital information tool in the emergency department.

A growing body of research documents the sustained decline in fertility across both developed and developing countries, with total fertility rates (TFR) in many contexts falling well below replacement level. Recent projections published in The Lancet suggest that by 2050, nearly three-quarters of countries will have fertility rates insufficient to maintain population size (). The persistence and depth of this decline have raised concerns about population aging, labor force contraction, fiscal sustainability, and long-term economic growth. In response, an expanding literature seeks to identify the key determinants of fertility decline and evaluate the potential effectiveness of policy interventions. In Europe, recent policy responses have increasingly focused on comprehensive family welfare systems, including cash benefits, childcare provision, and tax incentives, which aim to reduce the economic burden of childrearing, although their effectiveness varies across institutional contexts (). Within this literature, increasing attention has been paid to the role of economic constraints in shaping fertility decisions. Existing research emphasized factors such as labor force participation, financial uncertainty, costs of living, and expenditure on education (–). In particular, housing affordability has emerged as a critical constraint. Housing is the largest expenditure for most households and directly affects both the timing and quantum of childbearing. High housing costs can delay household formation, reduce available resources for childrearing, and increase economic insecurity, thereby discouraging fertility. The discussions of the implications of low–low fertility have generated parallel explorations of how to slow the decline in fertility, perhaps even increasing it. Those discussions have taken on a pronatality narrative focused on the mechanisms which might increase fertility. Among the ideas included as policy solutions, the research has explored direct monetary subsidies, paid parental leave, service provision such as childcare, and indirect policies in the housing market. It is the last of these suggestions that is at the center of the research reported in this research. Globally rising housing prices impose substantial burdens on households considering childbearing. China offers a particularly informative setting, as rapid housing price growth has coincided with persistently low fertility. In response, China relies on the Housing Provident Fund (HPF), a mandatory savings-based housing finance system that provides preferential mortgage credit and reduces housing cost burdens. This institutional framework creates a valuable opportunity to examine how housing credit access affects fertility behavior.