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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Coronavirus

Where Lockdowns For LGBTQ Meant Moving Back In With Homophobic Relatives

The confinement experience could turn brutal for those forced to live with relatives who would not tolerate a member of the family living their sexual orientation openly as a young adult. Here are stories from urban and rural India.

At a Rainbow pride walk in Kolkata, India

Sreemanti Sengupta

Abhijith had been working as a radio jockey in the southern Indian city of Thiruvananthapuram when the COVID-19 pandemic hit in March, 2020. When the government imposed a nationwide lockdown, Abhijith returned to the rural Pathanamthitta district , where his parents live with an extended family, including uncles, cousins and grandparents.

Eighteen months later, he recalled that the experience was "unbearable" because he had to live with homophobic relatives. "Apart from the frequent reference to my sexual 'abnormality', they took me to a guruji to 'cure' me," Abhijith recalled. "He gave me something to eat, which made me throw up. The guru assured me that I was throwing up whatever 'demon' was possessing me and 'making' me gay."


Early in 2021, Abhijith travelled back to Thiruvananthapuram, where he found support from the members of the queer collective.

Inspired by their work, he also decided to work towards uplifting the queer community. "I wish no one else goes through the mental trauma I have endured," said Abhijit.

Abhijith's story of mental distress arising from family abuse turns out to be all too common among members of India's LGBTQ+ community, many of whom were trapped in their homes and removed from peer support groups during the pandemic.

Oppressive home situations

As India continues to reel from a pandemic that has claimed more lives (235,524) in three months of the second wave (April-June 2021) than in the one year before that (162,960 deaths in March 2020-March 2021), the LGBTQ community has faced myriad problems. Sexual minorities have historically suffered from mainstream prejudice and the pandemic has aggravated socio-economic inequalities, instigated family and institutionalized abuse, apart from limiting access to essential care. This has resulted in acute mental distress which has overwhelmed queer support infrastructure across the country.

Speaking to queer collective representatives across India, I learned that the heightened levels of distress in the community was due to longstanding factors that were triggered under lockdown conditions. Family members who are intolerant of marginalized sexual identities, often tagging their orientation as a "disorder" or "just a phase", have always featured among the main perpetrators of subtle and overt forms of violence towards queer, trans and homosexual people.

Calls from lesbians and trans men to prevent forced marriages during lockdowns.

Sappho For Equality, a Kolkata-based feminist organization that works for the rights of sexually marginalized women and trans men, recorded a similar trend. Early in the first wave, the organization realized that the existing helpline number was getting overwhelmed with distress calls. It added a second helpline number. The comparative figures indicate a 13-fold jump in numbers: from 290 calls in April 2019-March 20 to 3,940 calls in April 2020-May 2021.

"Most of the calls we have been getting from lesbians and trans men are urgent appeals to prevent forced marriages during lockdowns," said Shreosi, a Sappho member and peer support provider. "If they happen to resist, they are either evicted or forced to flee home. But where to house them? There aren't so many shelters, and ours is at full capacity."

Shreosi says that the nature of distress calls has also changed. "Earlier people would call in for long-term help, such as professional mental health support. But during the pandemic, it has changed to immediate requests to rescue from oppressive home situations. Often, they will speak in whispers so that the parents can't hear."

Lack of spaces

Like many of his fellow queer community members, life for Sumit P., a 30-year-old gay man from Mumbai, has taken a turn for the worse. The lockdown has led to the loss of safe spaces and prolonged residence at home.

"It has been a really difficult time since the beginning of the lockdown. I am suffering from a lot of mental stress since I cannot freely express myself at home. Even while making a call, I have to check my surroundings to see if anybody is there. If I try to go out, my family demands an explanation. I feel suffocated," he said.

The pandemic has forced some queer people to come out

Sumit is also dealing with a risk that has hit the community harder than others – unemployment and income shortage. He's opened a cafe with two other queer friends, which is now running into losses. For others, pandemic-induced job losses have forced queer persons from all over the country to return to their home states and move in with their families who've turned abusive during this long period of confinement.

Lockdowns force coming out

According to Kolkata-based physician, filmmaker and gay rights activist Tirthankar Guha Thakurata, the pandemic has forced some queer people to come out, succumbing to rising discomfort and pressure exerted by homophobic families.

"In most cases, family relations sour when a person reveals their identity. But many do not flee home. They find a breathing space or 'space out' in their workspaces. In the absence of these spaces, mental problems rose significantly," he said.

Not being able to express themselves freely in front of parents who are hostile, intolerant and often address transgender persons by their deadname or misgender them has created situations of severe distress, suicidal thoughts and self-harm.

Psychiatrist and queer feminist activist Ranjita Biswas (she/they) cites an incident. A gender-nonconforming person died under suspicious circumstances just days after leaving their peer group and going home to their birth parents. The final rites were performed with them dressed in bangles and a saree.

"When a member of our community asked their mother why she chose a saree for someone who had worn androgynous clothes all their life, she plainly said it was natural because after all, the deceased 'was her daughter,'" Biswas recalls.

The Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling

David Talukdar/ZUMA

"Correctional" therapy

In India, queer people's access to professional mental healthcare has been "very limited," according to community members such as Ankan Biswas, India's first transgender lawyer who has been working with the Human Rights Law Network in West Bengal.

"A large majority of the psychiatrists still consider homosexuality as a disorder and practice 'correctional therapy'. It's only around the big cities that some queer-friendly psychiatrists can be found," Biswas said. "The pandemic has further widened the inequalities in access to mental health support for India's LGBTQ community."

Biswas is spending anxious days fielding an overwhelming amount of calls and rescue requests from queer members trapped in their homes, undergoing mental, verbal and even physical torture. "We don't have the space, I just tell them to wait and bear it a little longer," he said.

Medical care is dismal

Anuradha Krishnan's story, though not involving birth family, outlines how the lack of physical support spaces have affected India's queer population. Abandoned by her birth family when she came out to them as a trans woman in 2017, Anuradha Krishnan (she/they), founder of Queerythm in Kerala who is studying dentistry, had to move into an accommodation with four other persons.

Isolation triggered my depression

"I am used to talking and hanging around with friends. Isolation triggered my depression and I had to seek psychiatric help." Living in cramped quarters did not help with quarantine requirements and all of them tested positive during the first wave.

What is deeply worrying is that the Indian queer mental health support infrastructure, already compromised with historical prejudice, is now struggling, placing more and more pressure on queer collectives and peer support groups whose resources are wearing thin.

During the 10 months of the first wave of the pandemic in India in 2020, Y'all, a queer collective based in Manipur, received about 1,000 distress calls on their helpline number from LGBTQ+ individuals. In May 2021 alone, they received 450 such calls (including texts and WhatsApp messages) indicating a telling escalation in the number of queer people seeking help during the second wave.

As India's queer-friendly mental health support infrastructure continues to be tested, Y'all founder, Sadam Hanjabam, a gay man, says, "Honestly, we are struggling to handle such a large number of calls, it is so overwhelming. We are also dealing with our own anxieties. We are burning out."

Sreemanti Sengupta is a freelance writer, poet, and media studies lecturer based in Kolkata.

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