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China 2.0

Why The World's Largest Country Is Struggling With Infertility

Obstetrician inspects a pregnant woman in Hefei, China
Obstetrician inspects a pregnant woman in Hefei, China
Wen Shuping, EO

BEIJING — It's been more than a year since China abolished the one-child policy ntroduced in 1979 to control the population. The politburo came up with a new two-child policy and simplified the government-approval process for couples seeking assisted reproductive treatment. The shift prompted older couples to use frozen semen and eggs, and test-tube babies.

So far, China's baby boom hasn't gone as expected. Data from the China Population Association shows that as many as 50 million men and women of childbearing age suffer from infertility. Geng Linlin, deputy director of the clinical medicine center at the National Health and Family Planning Commission, says that infertility is becoming the greatest challenge for couples who have the economic capability and desire to have more than one child.

Dr. Wang Lina, director of the obstetrics and gynecology ward at the Third Hospital of Peking University, says that more than 10 million infertile married couples are deprived of becoming parents. Moreover, 15% of pregnant women experience a miscarriage. One-third of women who've had a previous miscarriage miscarry again. Meanwhile, among the women who give birth, 5.6% of the newborns have a birth defect. Mothers over the age of 35 see birth defect rates of 8% to 15% in their newborns — twice the rate of advanced countries.

Lu Qun, chief physician and professor at the reproductive center of the People's Hospital of Peking University, says age plays an important role in childbearing because it determines the quantity, as well as quality, of ovaries. Not only does advanced age reduce the chance of fertility, it also significantly increases the possibility of congenital deformities.

In China, women who would have liked to have a second child but couldn't because of the country's previous policy are now trying to get pregnant. Women have also been delaying getting pregnant in order to pursue their careers. These factors have contributed to a drop in the fertility of Chinese couples. Impaired ovarian function not only affects the chance of conceiving but also increases the risk of miscarriage.

According to data from the World Health Organization, about half of all mothers in China undergo a Caesarean section delivery — the world's highest rate. This far surpasses the 15% level that WHO says should trigger alarm bells. While many doctors and hospitals advocate for the surgery to make money, fear of natural delivery pain and hope for a baby's birth on an "auspicious day" also play a role.

China's high rate of Caesarean spells bad news for couples hoping for a second child. "Mothers with a uterine scar face risks during a second childbearing. As the fetus grows bigger during late pregnancy, sometimes there may occur a uterine rupture that may even be life-threatening," Dr. Geng Linlin told a forum entitled ‘The two-child era: technology, innovation and ethics' that was recently held in Beijing.

Doctors advise women who have previously had a Caesarean delivery to make sure, at an early stage of the pregnancy, that the implantation of the fertilized egg isn't located near the scar of their last operation to avoid heavy vaginal bleeding and a late uterine rupture. They recommend this especially for women over 35 years old who are considering a child.

In recent years, many experts have called on the government to loosen regulations concerning surrogacy services — still illegal in China — for families who have lost their only child. "Because of China's previous family planning policy, a group of people called Shi-du, which means ‘those who lost their only child," has appeared," says Wang Yifang, a professor at the Institute of Health and Humanities at Peking University.

"Though they may have lost their reproductive capacity, their sperm and ovaries may still be viable. They should be supported emotionally to have another offspring. Ethics in this case should not become a burden but a tool in promoting the orderly development of surrogacy services," says Wang.

It's best to get pregnant while still relatively young, says Dr. Wang Lina. Older couples who want to become parents need to shorten the period of time they need to conceive. Those over the age of 38 need to consult doctors as early as possible, she notes.

Dr. Wang Lina believes that keeping surrogacy services illegal, especially for patients who have had their uterus removed, deprives women of their right to be parents. Moreover, she says, this policy leads to the existence of a black market that causes severe hazards. She says that legislation and the strengthening of technologies that supervise childbirth are better options to focus on.

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