The cost of childbirth ranks second in the world! How to break the low fertility situation in our country?

The current population development in China shows a trend of fewer children, aging, and regional population differentiation. The sustained low fertility situation is affecting the overall sustainable development of Chinese society. According to the Yuwa Population Research Report, the average cost of raising a child to the age of 18 in Chinese households in 2020 was 485000 yuan. The average cost of childbirth is a multiple of per capita GDP, second only to South Korea and ranking second in the world.

China is at a historical turning point in the development of its population, shifting from population growth to population reduction, and the future is full of risks and challenges. The formation of a low fertility situation was not achieved overnight, why are young people generally unwilling to have more children nowadays? How to build a fertility friendly society? Recommend the latest article from the People's Forum.

Why is low fertility a challenge and crisis?

China's population experienced negative growth in 2022, marking the first negative growth since 1962. According to data from the National Bureau of Statistics, 9.56 million people were born nationwide in 2022, with a birth rate of 6.77 ‰; 10.41 million people died, with a population mortality rate of 7.37 ‰; The total population is 14117.5 billion, a decrease of 850000 compared to 2021. This is the first time since 1950 that the annual birth rate has dropped below 10 million, and it is also the third consecutive year that the birth rate has fallen below 1%. Behind the negative population growth is the low fertility rate where the population has been consistently below replacement levels. The number of births in China has been continuously declining for six years from 2017 to 2022. The seventh national population census data shows that in 2020, the total fertility rate of women of childbearing age in China was 1.3, which is at a very low level of fertility. According to the birth population data released by the National Bureau of Statistics, the total fertility rate in China in 2022 is only 1.07, making the situation even more severe. In 2022, China's birth rate was 9.56 million, accounting for only 7.2% of the global birth rate. As a reference, even with the encouragement of childbirth, the total fertility rate in South Korea has dropped to 0.78 in 2022. Internationally, it is generally believed that a total fertility rate of around 1.5 is a "highly sensitive warning line", and once it drops below 1.5, there is a possibility of falling into the "low fertility trap".

According to the Yuwa Population Research, under the predicted scenario, China's birth rate will drop below 7 million by 2050, and only 2.38 million by 2100, accounting for only 2.2% of the global birth rate. From 2023 to 2100, China's birth rate has experienced the largest decline, with its global proportion decreasing from 7.2% to 2.2%. The birth rates in India and Indonesia have also declined to varying degrees, while the birth rates in Pakistan, Nigeria, and the United States have increased to varying degrees. The birth rate in Russia has remained relatively stable. During the same period, China's total population also experienced the largest decline, with its share of the world decreasing from 17% to 6.1%, and it is the only populous country with a significant decline; The proportion of total population in India, Indonesia, the United States, and Russia has slightly decreased, while the proportion of total population in Nigeria and Pakistan has increased significantly. From a global population comparison, the severity of China's population decline is evident.

The seventh national population census data shows that the average population per household is 2.62 people, a decrease of 0.48 people from 3.10 people in 2010. A study by the China Population and Development Research Center, a subsidiary of the National Health Commission, showed that in 2020, the lifelong infertility rate for 49 year old women in China was 5.16%, lower than the average level in the United States and European Union countries. Researchers believe that although the current level of lifelong infertility among women in China is lower than that of developed countries in East Asia such as Japan, South Korea, and Singapore, the trajectory of the rise in lifelong infertility levels is similar to those of these countries. With the acceleration of urbanization, the continuous deepening of marriage and childbirth postponement, and the continuous improvement of education level, the population size and proportion of lifelong infertile women in China will continue to expand in the future. The sustained low fertility rate will become an important risk affecting the balanced development of China's population and the overall sustainable development of society. After all, the nature of the birth population is "sunrise population", so fertility largely determines the future of the population, and population affects future development.

Low fertility rate, low or negative population growth, and aging population are not unique phenomena in China, but challenges that the world will face in the 21st century. According to the 2022 World Population Outlook data released by the United Nations Population Division, in 2021, 38 countries were experiencing negative endogenous population growth, mainly due to long-term low fertility rates. The specific manifestations of the low birth crisis are the increasingly severe phenomenon of fewer children, the polarization of the aging population, and the shortage of human resources, as well as the resulting comprehensive elderly care problems, national security issues, and marital and family shocks.

According to the "China Population Census Yearbook 2020", the average age of first marriage for Chinese people increased to 28.67 years old in 2020. Further late marriage and childbirth will seriously squeeze the time for moderate childbirth and optimize the space for childbirth. China is at a historical turning point in the abnormal development of its population, shifting from population growth to population reduction. The future is full of uncertainty, risks, and challenges. The formation of a low fertility situation is not a single day's cold, with many complex characteristics such as endogeneity, long-term, severity, and stubbornness. If the situation of unmarried infertility or only married infertility and having only one child becomes increasingly common, then family development, elderly care, and sustainable social development will all face risks. When the fertility level is below the replacement level for a long time, it is impossible to achieve sustainable population development, and the sustainable development of families or society cannot be discussed.

What is the attribution of low fertility?

Why are young people nowadays generally unwilling to have more children? The reasons are complex and diverse. In summary, childbirth is an economically rational behavior, mainly due to the high cost, risk, and cost of childbirth, while the benefits, utility, and return of childbirth are too low, generally entering a cost constrained low fertility period.

The cost of childbirth includes both economic and non economic costs. The Yuwa Population Research Report estimates that the average cost of raising a child to the age of 18 in Chinese households in 2020 was 485000 yuan. The average cost of childbirth is a multiple of per capita GDP, second only to South Korea and ranking second in the world. According to the 2021 online survey on the cost of raising children conducted by China Economic Times, 80% of respondents believe that the economic cost of raising children is too high, and over 50% of respondents feel that they lack time to raise and take care of their children.

Objectively speaking, childbirth also carries certain risks, including a certain proportion of birth defects and reproductive health problems, especially for older mothers who may suffer from postpartum depression or even have concerns about their lives. Even in high-tech urban societies, the maternal mortality rate cannot be reduced to zero percent. The cost of childbirth includes the cost of health, such as taking care of children leading to physical exhaustion and damage to appearance, beauty loving women worrying about losing their figure and appearance after giving birth, as well as mental sacrifices, once a child is born, they need to spend time and energy to accompany and grow, and various worries and anxieties about how the child can achieve better development.

The current intensive care model has become a universal parenting model, driven by the social psychology of expecting children to become dragons and daughters to become phoenixes. Most parents are more or less anxious about comparison. The economic downturn makes it difficult to support a family, there is a lot of pressure to raise children, there is not enough housing space, there is no manpower to take care of young children, there is a lack of time to take care of and accompany children, and children face various parenting challenges during their growth process, all of which test the family's ability to raise and love. If raising a first child brings more difficult and even painful experiences to parents, especially mothers, the energy and cost required to have a second child have already made many couples feel discouraged, let alone having a third child.

The changes in fertility concepts brought about by social transformation and cultural upheaval. After a rapid demographic and social transformation, the traditional culture of having multiple children and preferring boys has drifted away. The carrier of traditional fertility culture, which is based on the family's decision-making model, has been transformed into a female dominated decision-making model. Although raising children is a common responsibility of couples and even families, it is evident that in today's society, childcare responsibilities still mainly focus on women. The gender discrimination faced by women in the workplace, as well as the many difficulties in balancing time and energy between work and education, destined them to bear more and heavier childbearing pressure than men. With the rise of women's liberation and feminist movements in the world today, women's reproductive and decision-making power has significantly increased, and their willingness and voice as the main body of childbirth have been more demonstrated. The extension of women's education years and widespread labor participation have made it a reality for unmarried and infertile, late marriage, late childbirth, and delayed childbirth. Low fertility has become a common problem faced by developed countries and China. The overall shift in the concept of childbirth is towards having fewer and better children. According to a survey conducted by the National Health Commission in 2021, the willingness of women of childbearing age to have children continues to decline, with an average planned number of children of 1.64, lower than 1.76 in 2017 and 1.73 in 2019. The number of "post-90s" and "post-00s" who are the main body of childbirth is only 1.54 and 1.48. The heavy economic burden, lack of care for children, and women's concerns about career development have become the main obstacles restricting fertility.

Low welfare expectations are also an important reason for the low fertility trend. Essentially, childbirth comes with benefits, and the growth of children will produce various benefits and effects. But with the evolution of parenting patterns, parent-child relationships, and intergenerational relationships, the utility of reproduction has decreased and even produced a net negative effect compared to the huge costs, costs, and sacrifices paid by the parents. This has led to some families with fertility potential now lacking "fertility enthusiasm".

In summary, under the background of economic downturn, the insufficient fertility capacity of families as reproductive units, the strong correlation between reproductive responsibilities and reproductive subjects, and the low willingness of women to have children directly constitute the internal driving force of low fertility. This is an important basis for China's transition from policy oriented low birth to endogenous low birth since the deepening of reform and opening up in the 1990s. A fertility friendly society is actually a child friendly and family friendly society, characterized by overall utilitarianism, lack of deep love and compassion, and a lack of selfless love for children, making it impossible to achieve moderate and optimized reproduction. Only by enhancing the collective and rational love for children in the whole society can we tap into the power sources of marriage harmony, family development, and overcoming the dilemma of low fertility.

How to build a fertility friendly society?

The construction of a fertility friendly society is aimed at addressing the systemic population crisis contained in low fertility, declining birth rates, and aging. Its essence is to support and encourage childbirth, in order to overcome the risks and difficulties of low fertility. Born or not born? How many children are born? It is not a simple issue, as it is influenced by both the actual considerations of the reproductive subject and various factors in the economic and social environment. Therefore, the construction of a fertility friendly society is a complex social system project promoted by multiple levels of the country, jointly responsible by the central and local governments, and jointly participated by enterprises, institutions, and the whole population. It requires multidimensional thinking and efforts, following the three basic logics of cultural friendliness, rights friendliness, and welfare friendliness in childbirth.

▲ One is the cultural friendliness of childbirth. Showcasing fertility friendliness in terms of culture and values is actually child friendliness, maternal and professional friendliness, family friendliness, elderly friendliness, national friendliness, and development friendliness. The cultural friendliness of childbirth is also known as cognitive friendliness. In other words, for families, countries, and society, the newborn population is a hopeful and promising population with unlimited potential and value. In a civilized society, regardless of whether children are healthy or disabled, they should be treated with kindness. As a reproduction activity of the population, childbirth belongs to a part of social labor, and the social value it creates is worthy of respect. The fertility culture, whether traditional or modern, has a common feature, which is that the basic culture of production and nurturing emphasizes a son's happiness - the welfare brought to humanity by passing on the family line and sustainable development. As the main body of childbirth, women need dual "maternal respect" from both family and society to help professional women maintain a balanced relationship between work and education, in order to moderately improve their fertility level.

Fertility has two basic attributes: value and humanity. We should vigorously promote the respect, understanding, tolerance, and support of the whole society, families, and parents for their children as "independent living beings", rather than treating children as private property, stubbornly understanding and shaping them from the perspective of self prejudice, and indulging, favoring, and lacking love that is not conducive to their growth. We should incorporate love and compassion into the soul of modern reproductive culture. Otherwise, even if the low fertility situation improves, it goes against the original intention of high-quality population development, because if children grow up in an environment lacking wisdom and love, it is difficult for them to become true talents.

▲ Secondly, the right to childbirth is friendly. Having a second child may be a difficult choice for an ordinary family. But for wealthy families, it may be a different scene. They may have a complex of having more children and a preference for boys, which challenges the inclusiveness of the policy of allowing a couple to have three children. Moreover, there are ordinary families who want to have more children, as well as some ordinary families who accidentally become pregnant but do not want to have their children aborted. Diversity is the true nature of fertility, and providing maximum tolerance for fertility is the only way to find opportunities to stimulate a rebound in fertility rates. Although the phenomenon of multiple births with three or more children is relatively rare, it should be tolerated, not only because every life is precious, but also because the weighted impact on increasing fertility rates is positive. The greatest inclusiveness of fertility policies in societies with low fertility is to return to the true nature of free and autonomous childbirth. The 14th Five Year Plan points out that "we will implement a national strategy to actively respond to population aging. We will formulate a long-term population development strategy, optimize birth policies, and improve the population service system with a focus on 'one elderly and one young', promoting long-term balanced population development." "We will enhance the inclusiveness of birth policies, promote the coordination between birth policies and economic and social policies, reduce the burden of family childbirth, parenting, and education, and unleash the potential of birth policies." This highlights the progressive population development and population governance views in the new development pattern. The diversity and ecological rationality of fertility intentions should be fully considered. Making having two to three children the mainstream of society is the fundamental way to get rid of the crises of low fertility, fewer children, and aging. Therefore, it is necessary to facilitate the arrival of the third demographic transition as soon as possible.

The third is the welfare friendliness of childbirth, which means that childbirth is not only a family matter but also a national matter. Fertility has both internal and external characteristics, and can be positive or negative. From the perspective of global governance, taking the path of welfare, socialization, and nationalization of childbirth is a common response for countries facing the challenge of sustained low fertility.

The types of reproductive benefits include material rewards, income improvement, service upgrading, and environmental optimization. Fertility welfare refers to profitability and increased expectations. The socialization of reproductive welfare means that some of the costs of childbirth, upbringing, and education should be borne by society. The nationalization of reproductive welfare means that the state should bear greater responsibility and define the main responsibility of reproductive welfare through institutionalized and legal means. Building a fertility welfare society with Chinese characteristics may be the only way for sustainable development of Chinese society. The "family friendly policy" proposed by UNICEF can be used as a reference. The "Family Friendly Policy" supports the need for families to take care of infants and young children, while also allowing parents to fulfill their work responsibilities and better balance parenting and employment. The balance issue of vocational education relationships among Chinese women is quite severe. Since the implementation of the comprehensive two child policy in China, the relatively heavy family care responsibility has had a serious maternal punishment effect on the entire employment process of urban women, especially for women with children aged 0-6. This effect is more pronounced, and it is objective to have more children and more daughters to bear. The adverse effects of taking on family parenting responsibilities run through the entire career and family life cycle of women. It is not uncommon for professional women with potential fertility needs to face discrimination in the workplace in reality. We need to carefully study and legislate to protect the employment rights and reproductive rights of professional women.

The welfare friendliness of childbirth mainly includes two welfare providers, namely the government and enterprises. Firstly, the first welfare of childbirth is friendly, that is, government friendliness. The state is the primary responsible party for the socialization of reproductive welfare, and government departments are the relevant responsible parties. The direction of efforts is to support and encourage childbirth. The government should add welfare benefits to families with two or three children, provide fair and just welfare treatment for national fertility, and establish a mature long-term mechanism. Simply put, it is important to ensure that eligible individuals who are willing to have children can afford to have them and take good care of them.

The maternity allowance is quite common in foreign countries, such as Japan's childcare allowance for families with children of junior high school and below, and whose income does not exceed the prescribed range. The subsidy amount is 15000 yen per month for children aged 0 to 2 years old; Among children aged 3 to elementary school, the first and second child costs 10000 yen, and the third and above child costs 15000 yen; The unified price for junior high school students is 10000 yen.

Singapore provides a cash bonus of SGD 3000 for babies born on or after February 14, 2023. Provide a cash reward of SGD 11000 each for the first and second children born to Singaporean couples. If a third or more children are born, the bonus will increase from SGD 10000 to SGD 13000.

Since the implementation of the three child policy on May 31, 2021, governments in many parts of China have started to gradually distribute maternity benefits and introduce parenting subsidies.

For example, from 2021, Panzhihua City, Sichuan Province, will be the first in the country to launch the policy of providing childcare subsidies to local registered residence families with two or more children, with 500 yuan per child per month until the child is 3 years old. Panzhihua City has also introduced the "Eight Measures to Create a Friendly Fertility Environment and a Bright City Card", building a fertility service guarantee system that covers pregnancy, childbirth, care, childbirth, and housing.

For example, in January 2023, the Shenzhen Health Commission of Guangdong Province publicly solicited opinions on the "Shenzhen Parenting Subsidy Management Measures", and initially proposed to distribute parenting subsidies to citizens in a differentiated and progressive manner. Families with one child can receive a cumulative amount of 7500 yuan, families with two children can receive a cumulative amount of 11000 yuan, and families with three children can receive a cumulative amount of 19000 yuan.

In August 2023, Hangzhou Health Commission and Hangzhou Finance Bureau issued a notice on the implementation measures of childcare subsidies in Hangzhou. From January 1, 2023, for the same couple, pregnant women with registered residence in Hangzhou will be given a one-time subsidy of 2000 yuan for their second child and 5000 yuan for their third child; For families with the same couple having two or three children since January 1, 2023, and the newly born children registered in registered residence, a one-time subsidy of 5000 yuan will be given for the birth of two children and 20000 yuan for the birth of three children. Those who give birth to multiple births are calculated separately based on the number of children they have.

The exploration of local governments has just begun, and it remains to be seen how effective it will be and whether it can meet expectations. The term "society" can be large or small, referring to national or regional societies, as well as small residential communities. China has a vast territory and significant regional differences. The creation of a fertility friendly society will present a diverse and integrated pattern, and various regions need to create intervention models with local characteristics according to their actual situations. At the national and social level, the key to making efforts is to break through the bottlenecks, coordinate arrangements, fill the gaps, and continue to promote a "package" of measures covering marriage, childbirth, parenting, education, and other aspects, forming a policy synergy of excellent pregnancy, childbirth, parenting, and education. If the "high" fertility rate can recover to 1.4 by 2025, then very effective policies to encourage childbirth are needed, such as fiscal expenditures to encourage childbirth reaching around 5% of GDP; And other corresponding supporting measures, such as significantly increasing the proportion of childcare enrollment to reach the level of developed Nordic countries, which is about 50%.

Secondly, the second welfare of childbirth is friendly, that is, business friendly. Starting from July 1, 2023, Ctrip will invest 1 billion yuan to subsidize employee childbirth. Ctrip employees who have been employed for over 3 years worldwide will receive an annual cash subsidy of 10000 yuan for every new child they give birth to, which will be distributed until the child reaches the age of 5. The launch of new parenting benefits aims to provide economic support for employees to have children, so that they will not sacrifice their career goals and achievements due to childbirth. This demonstrates the breadth of vision, foresight, and responsibility of maternity friendly enterprises. It is gratifying that the team of fertility friendly enterprises is growing and expanding, and the effect of geese flock is faintly visible.

Ultimately, the foundation of creating a fertility friendly society lies in how to view the low fertility crisis and establish what kind of fertility values. Fertility friendliness includes tolerance for having fewer children, as well as encouragement and support for having more and better children. The state and choices of diversified fertility, as long as they are rational and responsible, are worthy of respect. Of course, we are not cheering for the ultra-low fertility rate, but rather preparing for the new population problem in the era of low fertility, because the achievement of the low fertility goal does not mean the end of China's population problem, but is accompanied by the transformation of China's population problem. To this end, the country should build a community of understanding, society, and responsibility that is friendly to childbirth, vigorously promoting it from three directions: cultural friendliness, policy friendliness, and welfare friendliness.

Selected from the People's Forum magazine in August

Original Title | Low Fertility Crisis and the Construction of a Fertility Friendly Society