When China implemented its one-child policy four decades ago, policymakers said they would simply shift gears if births fell too much. It hasn’t been that easy.
“In 30 years, the current problem of particularly dire population growth can be mitigated and then [we can] Adopt different population policies,” the Communist Party said in a 1980 open letter to members and youth.
With the number of births declining year on year, China is now running in the opposite direction, closing abortion clinics and expanding services to help couples conceive. But the legacy of the one-child policy, which was abolished in 2016, coupled with a dwindling number of women of childbearing age, has only left a generation of children less eager to marry and start a family.
Furthermore, infertility appears to be a bigger problem in China than in many other countries. According to a survey by Peking University researchers, it affects about 18% of couples of reproductive age, compared to the global average of about 15%.
For years, the government called on women to postpone marriages to encourage smaller families. Researchers say the age at which Chinese women are trying to have children may be partly responsible for the comparatively high infertility rates. And some researchers say the widespread use of abortion over the years to call attention to birth restrictions may also play a role.
Many miscarriages affect women’s bodies and infertility is a possible consequence, said anthropologist Ayo Wahlberg of the University of Copenhagen, who has written a book about fertility research in China.
Decades of policies to keep births low have not only left deep wounds but also financial obligations for many local governments, which can dedicate themselves to encouraging births.
Shandong province is known for its sometimes excessive enforcement of birth restrictions in China, including a 1991 campaign in parts of the city of Liaocheng called “Hundred Days, No Child”. To improve their birth data, abortion centers forced women to become pregnant even though the child was their first and was allowed under the one-child policy.
“People of almost all ages here have heard something about him,” said a 45-year-old college teacher in Liaocheng, although he added, “It’s something you can’t find anywhere in written history.”
Beijing banned birth-control enforcement years later, which is considered too cruel, including imprisonment or beating of birth offenders and destroying their property. The National Health Commission did not respond to a request for comment. An official at the Shandong Provincial Health Commission declined to comment beyond saying that Shandong was amending its family planning law to encourage births.
Today, Shandong pays compensation or subsidies to millions of couples who lived by the rules, including retirees who no longer have support because their only child died or became disabled or had an abortion or other birth-control. Women injured in relation to statutes. In 2019, such outlays totaled more than five billion yuan, the equivalent of $780 million, according to the provincial health commission. This equates to more than one-fifth of that year’s biggest budget item, education spending.
The use of abortion has not fallen off a cliff. According to National Health Commission data, in 1991, the year of the 100-day campaign in Shandong, China had about 14 million abortions. In 2020 this number was less than nine million. More shockingly, the number of family planning centres, mainly used for abortion, sterilization and insertion of intrauterine devices, has decreased to 2,810 across China in 2020, less than 10% of the number. Is. in 2014.
Meanwhile, rounds of in vitro fertilization, or IVF—each round being a multistep process over four to six weeks—have more than doubled, from about 485,000 in 2013 to more than a million in 2018. In the US, a little more than 300,000 rounds were performed in 2018 at 456 reporting clinics, according to the Centers for Disease Control and Prevention.
“What is so surprising to me is that even after so many years [birth] Restrictions will probably make fertility clinics more important than abortion clinics,” Prof. Wahlberg said.
According to their research, assisted reproduction has a surprisingly long history in China. In March 1988, a decade after the birth of the world’s first test-tube baby in Britain, Beijing gynecologist Zhang Lizu gave birth to the first child in China to be conceived through IVF. Another three months followed in Changsha, under the guidance of a geneticist Lu Guangxi.
Both doctors had to conduct their research mostly in secret; Infertility services did not become legal until the early 2000s, with a one-child policy defining the demographic agenda.
Now, the methods Dr. Zhang and Lu have taken are one of the measures the government is counting on to shift the demographic trajectory.
The number of Chinese newborns declined by 18% in 2020 compared to a year ago, and data expected in January is likely to show another steep drop in 2021. China’s fertility rate—the number of children a woman will have in her lifetime—has already fallen below replacement levels. It dropped to 1.3 in the early 1990s and down from Japan’s 1.34 in 2020. After falling to a record low of 1.26 in 2005, Japan’s fertility rate, one of the world’s lowest, began to recover with support measures by the government, although in recent years, the rate has started to fall again.
According to the Health Commission, there are currently 536 infertility centers in China, but most are located in affluent metropolitan areas such as Beijing and Shanghai, and their quality varies widely. Major hospitals have added fertility services to family planning clinics, and China is also trying to bring such services to smaller cities.
The Health Commission has set a target of offering at least one institution for every 2.3 million to 3 million people by 2025. Nationwide, China is not far off target, but less economically developed provinces say existing services cannot meet growing demand. There are only three breeding institutes in the western province of Gansu, all in the provincial capital Lanzhou. Gansu has a target of seven by 2025.
One of the early pioneers of IVF, Dr. Lu founded one of the world’s largest fertility hospitals in Changsha in 2002, the Reproductive and Genetic Hospital of Sitic-Jiangya, which has collected more than 180,000 since its inception, according to his website. have given birth to children. , The average cost of a treatment cycle in a hospital is about 40,000 yuan, which equates to about $6,000.
After a miscarriage in 2018, an assistant professor at Beijing University, who gave only her last name, Wang, said she was not sure she would ever be able to become a parent. But last year she gave birth to a baby boy after IVF treatment.
His treatment cost a little over 50,000 yuan. “If I was a few years younger and if the whole process wasn’t so difficult, I’d have another one,” said Ms. Wang, 36.
Infertility-treatment costs are not covered by public insurance in China. In Japan, the government has proposed expanding public medical-insurance coverage for some infertility treatments.
But advancing infertility services only goes so far, said Copenhagen anthropologist Prof. Wahlberg said. “Low birth is a social issue, not just a biological one,” he said.
Chinese people’s ideas about family and birth have been reshaped in the past few decades, and the government’s latest efforts may not easily reverse it, said Yi Fuxian, a US researcher who has long supported the Chinese government. Population policies have been criticized. Mr. Yi hopes the 2021 figures may also show that China’s population is beginning to shrink years ahead of government forecasts.
To encourage births, some local governments have promised cash prizes and longer maternity leave. But some researchers question whether this is enough.
James Liang, a well-known businessman and research professor of economics at Peking University, who has long been an advocate for China’s lifting of birth restrictions, says it is better for China to stop its birth rate decline without major financial subsidies. will be difficult. Help families have more children.
“It all comes down to money,” said Mr. Liang. “You can’t change people’s minds or impose any kind of value system on them.”
They estimate that to raise the fertility rate to replacement levels, the government needs to subsidize families on average one million yuan, or about $160,000 per child, in the form of cash, tax exemptions and housing and daycare subsidies.
Wang Pian, a former family planning official who said in 2017 that China would be unlikely to face a population crunch “not in 100 years”, is now urging young people to be more responsible and have children. .
“We must focus on the social value of birth,” Mr Wang, now a political adviser, told state media.
About Beijing—from harshly restricting in six years how many children couples may now have to encouraging them to have more—makes little mention of the lingering effects of a one-child policy on the demographics, no matter what. Its human cost.
“I really have a lot of thoughts and sympathy for the women who grew up with the system that is now asking the state to let young women have children,” Prof. Wahlberg said. “My heart breaks when I think about that situation.”
Jilin, one of the northeastern provinces with the country’s lowest fertility rates, said last month that local banks would offer a 200,000 yuan government-backed credit line at reduced interest rates for each married couple with children.
The provincial government also said it would not pay any fines found for “historic” birth violations, adding that authorities need to convince residents punished for having too many children that the situation has changed and Now it “needs to stimulate birth potential”.
Never miss a story! Stay connected and informed with Mint.
download
Our App Now!!
,