The Chinese government has pledged to improve pre- and post-natal services to encourage more people to have children and reiterated its intent to “discourage” abortions as it seeks to turn around a declining birth rate.
The measures announced by the country’s national health commission include a pledge to make fertility treatments more accessible. For several years authorities have flagged expanding IVF access to single women but it remains available only to married couples. A court challenge by a woman was recently struck down.
The commission said it would guide local governments and health institutions to make the changes, including the provision of “targeted services to the masses through health education, psychological counselling, traditional Chinese medicine services, drug treatment, surgical treatment, assisted reproductive technology and other means to improve the level of infertility prevention and treatment”.
Reproductive health education campaigns would also be carried out to enhance public awareness while “preventing unintended pregnancy and reducing abortions that are not medically necessary”.
The measures were described as crucial for promoting the long-term balanced development of the population.
The guidelines mark the most comprehensive effort at a national level, including the attempt to reduce abortions, which have been generally readily accessible for many years. At least 9.5m abortions were carried out between 2015 to 2019, according to a report published by the commission at the end of 2021, but some experts believe the number to be far higher.
The government had previously publicly stated its intention to discourage “non-medical abortions” in September 2021 but has not yet defined what constitutes a “non-medical” abortion, or how it would discourage them, which has alarmed women’s rights groups.
China has one of the lowest birth rates in the world, and government efforts to encourage people to have more children have not yet been successful. The country is approaching a demographic crisis with the lowest population growth rate in more than six decades.
The high cost of living, delayed marriages and lack of social mobility are frequently cited as contributing factors to young Chinese people’s reluctance to have children, as well as the lingering impact of the government’s decades-long one-child policy, which included forced abortions.
In recent years, the government has lifted limits on the number of children a couple can have, introduced tax deductions and other incentives, and sought to address the high cost of raising a child, including by, in effect, shutting down the private tutoring industry.
Yi Fuxian, an obstetrics and gynaecology researcher at the University of Wisconsin-Madison, suggested Chinese authorities were having trouble shifting from the policy setting where a pregnancy was considered a burden, to one where it is a contributor to the country’s wealth.
The rollout of domestic policies was having little effect, Yi said, because couples did not want to have children, could not afford to, or were leaving marriage so late that they found themselves unable to.
“All economic and social policies have revolved around mainstream families with only one child … so young people protest by not having children, and Shanghai youth shout ‘we are the last generation’,” Yi said. “Only after making up for each shortcoming can the fertility rate be increased.”
Yi said many east Asian countries were struggling to address declining birth rates.
“In east Asia, Japan is the most successful country in encouraging fertility, and is the most generous in encouraging fertility, providing cash incentives, housing subsidies, free childcare, free education and free medical care for children under 16 years old,” he said. “Although the cost is high, the effect is not good. Japan’s fertility rate increased from 1.26 in 2005 to 1.45 in 2015 but fell to 1.30 again in 2021.”
Additional reporting by Xiaoqian Zhu