One is a ghost that haunts China. It’s the ghost of Mao Zedong, but it isn’t Mao who haunts China today-the ghosts are his political teachings and policies.
China’s “one-child policy” was introduced in 1978. The policy was designed to reduce the population of China and encourage more people to have children later on.
When China implemented its one-child policy four decades ago, policymakers said that if birth rates fell too low, they would simply switch gears. That hasn’t proven to be that simple.
In a 1980 open letter to members and young people, the Communist Party said, “The present situation of particularly awful population increase may be resolved in 30 years, and then [we] may embrace other demographic strategies.”
China is now rushing in the other direction, shutting abortion facilities and boosting programs to help couples conceive, as the number of births continues to decline year after year. However, the one-child policy, which was repealed in 2016, has left a legacy of fewer women of reproductive age and a generation of only children who are less motivated to marry and establish a family.
Furthermore, infertility seems to be a more serious issue in China than in many other nations. According to a study conducted by Peking University researchers, it affects roughly 18 percent of reproductive-age couples, compared to a worldwide average of about 15%.
For years, the government has urged women to delay marriage in order to promote smaller families. According to researchers, the greater age at which Chinese women attempt to have children may contribute to the country’s relatively high infertility rate. Some academics believe that the extensive use of abortions to circumvent birth limitations throughout the years may potentially be a factor.
According to demographers, China would struggle to reverse the decrease in births without financial aid to assist families afford children.
wu hong/Shutterstock/wu hong/Shutterstock/wu hong/Shutterstock/w
According to Ayo Wahlberg, an anthropologist at the University of Copenhagen who has authored a book on fertility studies in China, many abortions have an influence on women’s bodies, and infertility is a likely result.
Decades of birth control programs have left not just severe scars, but also financial responsibilities for many local governments, limiting their ability to invest in increasing births.
Shandong province is notorious in China for its sometimes harsh implementation of birth limits, such as the “Hundred Days, No Child” campaign that took place in portions of Liaocheng in 1991. Local authorities coerced pregnant women to abortion institutions to improve their birth records, according to a 2012 documentary by Hong Kong-based Phoenix Television, even if the baby was their first and authorized under the one-child policy.
“Almost everyone old enough here has heard something about what they did,” a 45-year-old Liaocheng college professor said, adding, “It’s something you can never find anyplace in recorded history.”
Years later, Beijing outlawed birth-control enforcement that was regarded overly harsh, such as the jail or beating of birth violators, as well as the destruction of their property. A request for response from the National Health Commission was not returned. Shandong’s provincial health commission official refused to comment other than to note that the province is changing its family planning rules to promote births.
Shandong currently compensates or provides subsidies to millions of couples who followed the laws, including seniors who are now unable to support themselves because their lone kid died or got crippled, as well as women who have been injured as a result of abortions or other birth-control techniques. According to the province health commission, such expenditures amounted more than five billion yuan ($780 million) in 2019. More over one-fifth of the year’s largest budget item, education expenditure, was spent in this way.
Abortion rates haven’t fallen to dangerously low levels. According to National Health Commission estimates, roughly 14 million abortions were conducted in China in 1991, the year of the Shandong 100-day campaign. In 2020, the number was little around nine million. More noticeable is the fact that the number of family-planning facilities, which are mostly used for abortions, sterilizations, and intrauterine device insertions, has decreased to 2,810 in 2020, fewer than 10% of the amount in 2014.
Meanwhile, the number of rounds of in vitro fertilization, or IVF, has more than doubled, from around 485,000 in 2013 to more than one million in 2018. Each cycle is a multistep procedure lasting four to six weeks. According to the Centers for Disease Control and Prevention, a little more than 300,000 rounds were done at 456 reporting clinics in the United States in 2018.
“What amazes me is that, after all these years of [birth] restrictions, fertility clinics may become more significant than abortion clinics,” Prof. Wahlberg remarked.
Assisted reproduction, according to his study, has a very lengthy history in China. Zhang Lizhu, a Beijing gynecologist, delivered China’s first IVF baby in March 1988, a decade after the world’s first test-tube baby was born in Britain. Three months later, another was launched in Changsha, this time under the direction of geneticist Lu Guangxiu.
With the one-child policy dictating the demographic agenda, both physicians had to perform their study primarily in secret. Infertility therapies didn’t become legal until the early 2000s.
In this photo, a lady in Wuhan, Hubei province, gets in vitro fertilization therapy, which has been more popular in recent years.
Photo credit: Reuters/aly Song
The strategies pioneered by Drs. Zhang and Lu are now among the tools the government is relying on to change the demographic trend.
The number of Chinese births plummeted 18 percent in 2020 compared to the previous year, and statistics due in January is projected to indicate a similar reduction in 2021. In the early 1990s, China’s fertility rate—the number of children a woman has during her lifetime—had already fallen below replacement levels, and by 2020, it had plummeted to 1.3, below even Japan’s 1.34. After plummeting to a record low of 1.26 in 2005, Japan’s fertility rate, which is among the world’s lowest, began to rise with the aid of government support measures, however it has recently begun to decrease again.
According to the health commission, China presently has 536 infertility facilities, however the majority are concentrated in rich urban regions such as Beijing and Shanghai, and their quality varies greatly. Fertility treatments have been incorporated to family planning clinics at major hospitals, and China is working to expand these services to smaller locations.
By 2025, the health commission wants at least one facility to give IVF to every 2.3 million to three million individuals. China is close to achieving its objective nationwide, but less economically developed areas claim that present services can’t keep up with increased demand. In Gansu’s western province, there are just three fertility facilities, all of which are located in Lanzhou, the provincial capital. By 2025, Gansu hopes to have seven.
Dr. Lu, an early IVF pioneer, established one of the world’s biggest fertility clinics in Changsha in 2002, the Reproductive and Genetic Hospital of Citic-Xiangya, which, according to its website, has delivered more than 180,000 babies since its start. A treatment cycle at the facility costs about 40,000 yuan, or around $6,000, on average.
Some Chinese municipal governments have provided monetary incentives and extended maternity leaves to promote births.
Tang Ke/Sipa Asia/Zuma Press photo
An assistant professor at a Beijing university who only supplied her last name, Wang, said she wasn’t sure she’d ever be able to become a mom after a miscarriage in 2018. After IVF therapy, she gave birth to a baby boy last year.
Her therapy was little more than 50,000 yuan. “I would have another one if I were a few years younger and if the entire process wasn’t so stressful,” Ms. Wang, 36, who was worried about another loss, said.
In China, the expenses of infertility treatment are not covered by state insurance. In Japan, the government has recommended that certain infertility treatments be covered by public health insurance.
However, Prof. Wahlberg, a Copenhagen anthropologist, believes that improving infertility care only goes so far. “Low birth rates are a societal problem, not just a biological one,” he said.
Chinese people’s attitudes on family and birth have shifted in recent decades, and the government’s current attempts will be difficult to reverse, according to Yi Fuxian, a U.S.-based scholar who has long opposed China’s population policy. Mr. Yi believes that statistics from 2021 will indicate that China’s population has begun to decline, years ahead of official projections.
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Some municipal governments have offered monetary incentives and extended maternity leave to promote births. However, other scholars dispute if this is sufficient.
Without large financial subsidies to help families afford more children, James Liang, a well-known businessman and a research professor of economics at Peking University who has long advocated for the lifting of China’s birth restrictions, says it will be difficult for China to stop the decline in its birthrates.
Mr. Liang said, “It all boils down to money.” “You can’t make people alter their minds or push a value system on them.”
He predicts that the government will need to assist families by one million yuan, or about $160,000 per kid, in the form of cash, tax refunds, and housing and childcare subsidies to bring the fertility rate to replacement levels.
Former family-planning official Wang Pei’an, who declared in 2017 that China will not suffer a population deficit “in a hundred years,” is now pushing young people to be more responsible and have children.
Mr. Wang, who is now a political consultant, said, “We should pay attention to the social worth of births.”
Beijing’s 180-degree turn—from sharply regulating how many children couples might have to now pushing them to have more—makes no mention of the one-child policy’s long-term demographic impact or human cost.
Prof. Wahlberg added, “I actually have a lot of feelings and pity for women who grew up in that environment and now are listening to the state pushing young women to have children.” “When I think of that circumstance, my heart hurts.”
Jilin, one of the northeastern provinces with the lowest fertility rate in the nation, said last month that local banks would grant each married couple with children a government-backed credit line of 200,000 yuan with reduced interest rates.
The provincial administration further said that any penalties imposed for “historical” birth infractions would not be refunded, and that authorities must explain to citizens who have been penalized for having too many children that the situation has changed and that they must now “stimulate birth potential.”
Liyan Qi can be reached at [email protected]
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The “how many babies were killed during the one-child policy” is a question that has been asked for years. China has officially confirmed that it had killed around 400 million children from 1978 to 2015.
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