Summary of Key Points
China's current birth rate continues to decline (7.92 million births in 2025, the lowest in the past five years, with a natural growth rate of -2.41‰). To promote the high-quality development of the population, the government is focusing on two main aspects: encouraging people to have children and ensuring they are able to have children. On one hand, it aims to reduce the risks of childbirth by improving the system for preventing birth defects (premarital/prenatal/pregnancy/neonatal screenings and subsidies for assisted reproduction), thereby making families feel more confident about having children. On the other hand, it is working to enhance fertility by standardizing fertility assessments and building fertility-friendly hospitals. Behind these policies is a commitment to providing comprehensive support for optimal birth outcomes and women's health throughout the entire pregnancy and childbirth process.
I. The Changing Demographic Situation Forces Policy Shifts: From "More Children" to "Better Children + Ability to Have Children"
Why is there a focus on birth defects and fertility now? The birth rate has been steadily decreasing, and the number of births in 2025 is even lower than after the slight rebound in the Year of the Dragon. The natural growth rate is now negative. Additionally, there is an increasing number of older mothers (women delaying their childbearing years), and the prevalence of infertility has risen, leading to issues such as "wanting to have children but being afraid due to potential defects" and "wanting to have children but being unable to due to decreased fertility." The policy no longer simply encourages childbirth but aims to address these two key concerns: first, ensuring that people feel safe having children (with healthy babies), and then ensuring that they are physically capable of doing so.
II. How to Prevent Birth Defects? Four Levels of Prevention to Minimize Risks
The government has established a "three-tier prevention system" to address birth defects from before conception to after birth:
1. Premarital/Prenatal Prevention (Level 1): Marriage screenings are encouraged (with a 76.9% screening rate in 2025, an 8.5% increase from 2020), and free prenatal check-ups are available in all counties and districts, including free folic acid supplements to prevent neural tube defects.
2. Pregnancy Prevention (Level 2): There are over 6,000 prenatal screening and diagnosis institutions that detect serious defects like Down syndrome, allowing for timely intervention if issues are found.
3. Postnatal Prevention (Level 3): Newborns are screened for three common diseases (phenylketonuria, congenital heart disease, hearing impairment), with screening rates approaching 100%. Some provinces offer additional genetic and metabolic disease screenings (for example, Beijing screens for 49 diseases).
In addition, there are special assistance programs for children with birth defects from financially disadvantaged families, having helped 140,000 individuals so far. During the "14th Five-Year Plan" period, the government plans to provide financial support for assisted reproduction for families at high risk of genetic diseases and free diagnostic services for families with complex birth defects, providing double insurance for those who wish to have children.
III. Fertility Protection: From Haphazard Assessments to National Standards
For those who want to have children but cannot, the policy focuses on standardizing fertility assessments and providing comprehensive services:
- Fertility Assessments Must Be Standardized: Previously, assessment methods varied from region to region. Now, the government is developing unified technical guidelines to ensure consistency nationwide, avoiding discrepancies in results. Provinces like Shanxi and Jiangsu have already incorporated fertility assessments into their marriage screenings, and health institutions are encouraged to offer these assessments as optional services.
- Fertility-Friendly Hospitals and Early Pregnancy Clinics: The government supports the establishment of fertility-friendly hospitals and requires 10,000 institutions to set up early pregnancy care clinics that provide tailored services for different groups (planned pregnancies, unplanned pregnancies, high-risk pregnancies). For example, older mothers receive more detailed prenatal care, and unplanned pregnancies receive timely counseling.
- Reducing Urban-Rural Disparities: 24 provinces have achieved full coverage of prenatal check-ups in both urban and rural areas, ensuring that rural couples can also access quality birth-related services. The goal for 2025 is to cover 93.3% of the target population.
IV. Where Does the Money Come From? Government Funding and Special Subsidies
These services are not funded by the public:
- Basic Public Health Services: Prenatal check-ups, folic acid supplements, and neonatal screenings are covered by national funding, eliminating the need for individuals to pay out of pocket.
- Special Assistance: For families with financially difficult situations, additional support is provided through medical insurance, major illness insurance, and government assistance programs.
- Future Subsidies: During the "14th Five-Year Plan" period, the government plans to cover the costs of assisted reproduction for families at high risk of genetic diseases and provide free diagnostic services for families with complex birth defects, helping to share the costs of having healthy children.
V. What Challenges Remain?
Despite significant progress, there are still some challenges:
- Lack of Data: There is a lack of large-scale data on certain birth defects, such as immune deficiencies, making it difficult to implement unified screening programs. Local authorities must expand screening efforts based on their specific circumstances (for example, Beijing and Shanghai have already started trials).
- Inconsistent Capabilities: The prenatal diagnosis and genetic counseling capabilities in grassroots hospitals need to be improved.
- Inadequate Coverage: The range of diseases screened varies by region, and efforts are needed to expand coverage.
However, the government is taking steps to address these issues: it plans to improve the monitoring network, increase the number of diseases screened, and promote research on immune deficiencies. Overall, the current policy aims to not just encourage childbirth but to ensure that children are born healthy and that families have the necessary support to have children. This approach is both necessary to address the demographic situation and a crucial step towards improving the quality of the population.