China’s declining fertility rate
BMJ 2024; 385 doi: https://doi.org/10.1136/bmj.q1000 (Published 09 May 2024) Cite this as: BMJ 2024;385:q1000
- Hong-tian Li, associate professor1,
- Jin-Ling Tang, professor2,
- Jie Qiao
, professor3
- 1Institute of Reproductive and Child Health, National Health Commission Key Laboratory of Reproductive Health, Peking University School of Public Health, Beijing, China
- 2Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong Province, China
- 3State Key Laboratory of Female Fertility Promotion, Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Peking University Third Hospital, Beijing, China
- Correspondence to: J Qiao jie.qiao{at}263.net
China had the largest population in the world for many decades. Its total fertility rate (the average number of children a woman is expected to have in her lifetime) was as high as 6.0 before 1970, then decreased to 1.5-1.7 by the late 1990s. The rate remained stable until the early 2010s and then fell again.1
In an attempt to increase birth rates, China replaced its one child policy—introduced in 1979— with a universal two child policy from 2015. However, the total fertility rate continued to fall, reaching 1.3 by 2020.2 Additional pronatalist measures followed in 2021 but did not reverse the trend. In 2023, just 9.02 million babies were born in China, half the number born in 2016.
As societies become more prosperous and women achieve greater equality in education and employment, a falling birth rate seems unavoidable. In addition to rapid socioeconomic development and urbanisation, China’s family planning policies (including policies encouraging later childbearing, …
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