China’s abortion problem can’t be regulated away

By Yi Fuxian, Senior Scientist, Obstetrics and Gynaecology – University of Wisconsin-Madison ; Author, Big Country with an Empty Nest

Falling fertility rates and high rates of abortion have confronted China with a “demographic crisis” according to Yi Fuxian.

As a result, the authorities announced a population increase of only 480,000 in 2021, compared to increases of two million in 2020 and 4.7 million in 2019. It therefore seems inevitable that China’s population will begin to decline in 2022, nine years earlier than expected. China is facing a demographic crisis that exceeds the imagination of the Chinese authorities and the international community.

In fact, China’s demographic crisis is much worse than official figures suggest. That is why the authorities have rushed out a series of measures over the past few months, including restrictions on abortion. Likewise, crackdowns on private tutors are part of an effort to lower the cost of parenting.

But reducing the incidence of abortion in China is easier said than done. In the past, the authorities regarded the country’s large population as a burden, and the one-child policy not only encouraged women to have abortions but also involved the government in forcing them to do so. From television screens to giant outdoor billboards to roadside electricity poles, abortion advertisements are everywhere in China. Abortion is regarded as casually as dining out and is widely available in hospitals and clinics.

Unsurprisingly, China’s abortion ratio, or the number of abortions per 100 pregnancies, is very high by international standards, at 43 in 2020. That compares to ratios of 15 per 100 pregnancies in Japan, 13 in Taiwan, 19 in the United States, and less than three in India in recent years. One consequence of China’s high abortion rate has been a rapid increase in the infertility rate, from 1-3 percent in the early 1980s to 18 percent in 2020 – much higher than in developed countries such as the US.

Abortion is of course a highly sensitive issue, pitting a woman’s choice not to have a child against the opponents’ view that fetuses have rights. Roe v. Wade, the US Supreme Court’s landmark 1973 decision recognising a constitutional right to abortion, set off what some have called the “Second Civil War”, and US lawmakers have subsequently sought to impose several restrictions, including those contained in the 2003 Partial-Birth Abortion Ban Act.

Under China’s brutal one-child policy, abortion was a battleground between government coercion on the one hand, and parents’ reproductive rights on the other. But in 2021, the Chinese authorities further loosened family-planning rules, permitting households to have three children, rather than two, and they are expected soon to abandon their population-control policy entirely.

Such a move will, one hopes, trigger a corresponding shift in attitudes in China regarding childbirth, human dignity, and human rights. While the US and many other countries have long debated abortion and reached some consensus and compromise, the Chinese have not. China will no doubt learn from America’s efforts to limit abortion, but its measures will probably not be as strict as those in the US and Russia. And prohibiting abortion entirely will be impossible.

Even if China restricted abortion as tightly as the US does, its abortion ratio probably would still be much higher than America’s. Although the Chinese government has been cracking down on sex-selective abortions, the sex ratio at birth had long been as high as 120 boys per 100 girls, well above the normal ratio of 102-106 boys per 100 girls. Even in 2021, after five years of the two-child policy, the ratio was still 112 boys for every 100 girls.

Reducing the abortion rate will require China also to strengthen family values, provide better sex education to teenagers, and improve young people’s employment prospects and parenting abilities. Without such coordinated reforms, merely restricting abortion will be counterproductive. It could even trigger other social crises, such as an increase in the number of abandoned children and a spike in illegal abortions, which would threaten the health and lives of many women.

Yi Fuxian, a senior scientist in obstetrics and gynecology at the University of Wisconsin-Madison, is the author of Big Country with an Empty Nest (China Development Press, 2013).

Banner image: Women's hospital. Credit: Shutterstock.

Copyright: Project Syndicate,