<p>Fertility and employment are two major livelihood issues that garner significant attention in numerous countries. Based on the data from the experimental section of the 2021 China General Social Survey questionnaire, this paper systematically examines the impact of non-agricultural employment on multiple-child fertility intention among rural reproductive-age women. The findings reveal that non-agricultural employment significantly reduces multiple-child fertility intention among this group, with the concept change effect serving as an important underlying mechanism. Moderation effect analysis indicates that family care and medical service play moderating roles in the inhibitory effect of non-agricultural employment on multiple-child fertility intention. Specifically, on the one hand, within the realm of family care, elderly care intensifies the inhibitory effect of non-agricultural employment on multiple-child fertility intention, whereas intergenerational care mitigates this effect. On the other hand, improvements in both the time accessibility and spatial accessibility of medical service diminish the inhibitory effect of non-agricultural employment on multiple-child fertility intention. Heterogeneity analysis reveals that the negative impact of non-agricultural employment on multiple-child fertility intention among rural reproductive-age women is more pronounced for those in the stable phase of fertility decision-making, with lower levels of educational attainment, engaged in full-time non-agricultural work, whose spouses are also employed in non-agricultural sectors, and whose families do not participate in medical insurance or pension insurance schemes. This study holds significant theoretical implications and practical value for China and other developing countries in balancing the participation of reproductive-age women in non-agricultural employment with the enhancement of their fertility intention within the context of rural development.</p>