Xinhua reports that Shanghai has included a dozen types of Assisted Reproduction Technology (ART) in basic health insurance to ease the burden of infertile couples’ wanting to use IVF to conceive but are deterred by expensive fertility treatments.

The latest measure which has been implemented in the provinces of Jiangsu, Qinghai, Zhejiang, and Jiangxi starting 1 June 2024 is indicative of China’s efforts to stem the declining birth rate and raise the birth rate!

In the past year, six other provincial-level regions, including Beijing, have already included ART in basic health insurance.

Services ranging from sperm extraction to ‘in vitro fertilization’ (IVF) will be reimbursed in 35 facilities across Jiangsu.

In 2023, China’s population fell for a second consecutive year.

According to China’s National Bureau of Statistics the total number of people in China dropped by 2.08 million, or 0.15%, to 1.409 billion in 2023.

Current official population projections have actually tended to underestimate the extent of these challenges, precisely because they are based on shaky statistical assumptions that fertility rates will “rebound” in coming decades. China’s descent to ultra-low fertility indicates far more rapid societal aging than anticipated.

This was well above the population decline of 850,000 in 2022. In 2023, new births fell 5.7% to 9.02 million and the birth rate was a record low 6.39 births per 1,000 people, down from a rate of 6.77 births in 2022.

ART coverage means that basic health insurance will pay for at least 50% of the fertility treatment expense.

Hospitals in Shanghai receive 100,000 patient visits for ART annually. Health insurance coverage of ART will reportedly, on an average, save each patient about 9,000 Yuan on the treatment.

In Shanghai, the entire vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycle costs about 30,000 Yuan (US$ 4,220).

Reduction in ART expenses could increase access to treatments for a growing number of infertility couples, as China faces a declining birth rate, especially in large cities.

China’s National Healthcare Security Administration (NHSA) had issued a set of guidelines in June last year to intervene in fertility treatment pricing.

The guidelines state that hospitals need to provide ART at guidance prices or at prices not higher than those set by the government.

Bloomberg reports that Chinese stocks linked to reproductive health and infant care rose in the wake of the government’s decision.

Jianxin Fertility Group Ltd. (Hong Kong) jumped by 4% in morning trading (2 July) while Annil Co, the children’s apparel maker went up by as much as 6.2% onshore.

However they are finding it difficult in view of their own policies like the one-child policy and a slowing economy, both of which have created socio-economic conditions in which individuals are reluctant to raise children.

It is assessed that pricey fertility procedures will now be alleviated and make them more accessible.

This is especially so for couples who are willing to have children but face reproductive challenges.

Statistics reveal that China’s infertility rate has risen from 2% in the 1950s to 18.5% today.

Significantly, every one in eight couples of reproductive age needs ART in China today. In the capital city Beijing, ART has been included in basic health insurance since July 2023 and by end-March 2024, 32,000 patients received ART.

The total expense was 280 million Yuan, of which 190 million Yuan was paid for by basic health insurance.

The important thing is that health insurance coverage has lowered the threshold for patients to receive the treatments in terms of finance.

Meanwhile, reports indicate that some patients have waited until ART was included in basic health insurance in order to undergo egg retrieval.

In addition to recent measures to stem declining birth rates, China has also added many types of fertility medication to its national reimbursement drug list.

Faced with declining birth rates, the Chinese government has recently introduced a number of initiatives to encourage childbearing including relaxation in the one-child policy, provision of financial incentives, extending maternity leave and giving support to children.

Despite the slew of measures, the government continues to face difficulties in making Chinese citizens have children amidst the prevailing concerns about the slowing down of the economy, the high cost of raising children and pregnancy-related discrimination at the workplace.

An increasing number of Chinese women are delaying marriages and choosing not to have children.

They often cite financial constraints and the need to prioritize careers to remain childless.

Options covering costly procedures such as IVF may help alleviate some of these pressures.

The average cost for  IVF in cities such as Shanghai is said to be between $4,500 to $5,000.

In July 2022, 17 Chinese authorities, jointly issued a set of guidelines, calling for local governments to gradually include appropriate labour pain management methods in health insurance.

By pinning hopes on unfounded assumptions about a rebound in national fertility rates in the future, China may be weakening its’ ability to appreciate the extent of the coming challenges posed by rapid demographic change, and undermining their ability to respond to the practical governance challenges that will inevitably result.

For those statistically minded, it may be noted that China has 539 ART-approved medical institutions and 27 sperm banks as of June 2021, and each year these facilities provide more than one million IVF cycles, as per experts at the National Clinical Research Centre for Obstetrics and Gynaecology.

As mentioned above, China saw its population drop for a second consecutive year in 2023 and just over 9 million babies were born that year, the lowest since the founding of the People’s Republic in 1949.

China’s latest announcement also comes against the backdrop of the court verdict (June 2023) for Teresa Xu, an unmarried 35-year old Chinese woman who had sued a public hospital in Beijing for violating her rights by refusing to freeze her eggs because she was unmarried.

Concerned about China’s rapid ageing population, political advisers had proposed in March 2023 that single and unmarried women should have access to egg freezing and IVF treatment, among other services.

There are multiple problems that China is currently facing, one consequent upon the other.

Declining birth rates are juxtaposed with an ageing population.

There is also the challenge of providing more jobs to youth who are in many cases over educated.

Notably, in the next decade, it is estimated that over 300 million people, currently aged between 50 and 60, will leave the Chinese workforce.

This is China’s largest age group, nearly equivalent to the size of the population of the United States!

The prevailing trend witnessing a decline in the birth rates, has been a problem recognised by the Chinese authorities.

However they are finding it difficult in view of their own policies like the one-child policy and a slowing economy, both of which have created socio-economic conditions in which individuals are reluctant to raise children.

In Chinese thinking, things will get better with policies like introduction of ART in basic health insurance.

Current official population projections have actually tended to underestimate the extent of these challenges, precisely because they are based on shaky statistical assumptions that fertility rates will “rebound” in coming decades. China’s descent to ultra-low fertility indicates far more rapid societal aging than anticipated.

By pinning hopes on unfounded assumptions about a rebound in national fertility rates in the future, China may be weakening its’ ability to appreciate the extent of the coming challenges posed by rapid demographic change, and undermining their ability to respond to the practical governance challenges that will inevitably result.

The long-term view presents a demographic challenge to China for which they are as yet unprepared.