How policies support childbirth, childrearing

By SHI YI and HAN RUNLIN / 05-16-2024 / Chinese Social Sciences Today

Children practice traditional performances at Hebei Village Folk Culture Experience Park in Beijing, Apr. 26. Photo: Fang Ke/CSST

In 2022, China’s total birthrate was 1.09, the lowest among the world’s most populous countries. The issue of declining birthrates has become a fundamental national condition that China’s social and economic development must overcome. It is increasingly urgent to enhance the birthrate and promote the long-term balanced development of China’s population through comprehensive social policies.

Basic questions

In life, childrearing is not an individual’s behavioral choice or a short-term event but a long-term process closely related to nurturing and education. Family planning is influenced by myriad factors such as economics, society, and culture, while career development, economic status, time allocation, and quality of life of family members also affect people’s willingness to give birth and have children. Clear research on China’s planned fertility support is a prerequisite for constructing a system of fertility support policies, and this requires policymakers to answer three questions: who will be supported, who will provide support, and what will be supported, to specify the objects, subjects, and contents of fertility support.

The object of this support should be families rather than individuals. In traditional approaches, women are seen as the direct actors, while the influence of men and other family members is often overlooked, resulting in previous fertility support policies that disproportionately focused on contraception, maternal health checkups, maternity insurance reimbursement, and women’s employment. To increase effectiveness, we could divide families into three groups to better provide fertility support. The first level of support is for the childbearing population, with the main goal of realizing their fertility desires and creating favorable conditions to alleviate family planning pressures. The second level of support is for infants and young children, with the goal of safeguarding children’s rights to healthy development. The third level of support is for caregivers, and this aims to enhance the perceived value of caregiving labor within families, encouraging shared responsibilities among all family members.

The subject of fertility support should be tackled by the public sector. In traditional societies with relatively simple social division of labor and incomplete welfare systems, families are both the primary recipients of fertility policy benefits and the main bearers of childrearing responsibilities and costs. In modern societies with increasingly specialized social division of labor and gradually improved welfare systems, the main recipients of fertility benefits have expanded from families to enterprises and also the state. Employers and the public sector should also bear some of the fertility responsibilities and costs.

Meanwhile, the content of family planning support should cover multiple dimensions, the first of which being time support. Time is a limited and non-renewable resource, and childcare demands a significant investment of time. Therefore, it is essential to continuously improve maternity leave policies through legislation, systematically share enterprises’ employment burden, explore flexible working arrangements, and strengthen workplace and public policy support, to create a child-friendly employment environment, thus alleviating the pressure on mothers in terms of time invested in childcare. 

Second, high birth and childcare costs are a major factor affecting the willingness of families to have children. Therefore, we need to actively construct a fertility-support-oriented basic system based on expanding maternity insurance coverage, developing it into a basic system that guarantees compensation during maternity and childcare leave for urban workers and rural residents, as well as childcare subsidies. 

Third, strategic investment in daycare, education, universal childcare services, support for infant care within families, and early childhood development guidance are much needed. At the same time, policymakers also need to improve public education services, uplift families’ sense of educational attainment, and enhance the level of basic healthcare services throughout the entire process of reproduction to ensure maternal and infant safety and health. 

Finally, in the process of raising children, public facilities are crucial social environments that families rely on. Therefore, it is necessary to strengthen public-level childcare resource support, enhance the public environment and community support capabilities for childbirth and childcare, and construct child-friendly public spaces conducive to travel, mother and baby care, infant care, and universal childcare.

Since the adjustment of fertility policies, government departments in China have introduced a series of policies approaching fertility support from different dimensions. 

However, a comprehensive, coordinated, and complete policy system has yet to be formed. Fertility support work is not evenly applied across different sectors, and systematic research has not been conducted to clarify responsibilities or possible ratios of shared responsibilities among the government, enterprises, families, and individuals. Financial burden distributions are also unclear, particularly between the central and local governments. This results in policies which lack systematic synergy, inclusion, and coordination. To say the least, daycare services are expensive, with low fiscal investment from the government. Maternity insurance coverage is also insufficient, with low benefit levels. There are prominent reproductive health issues and a lack of institutional guarantees.

Basic system

The policy framework for fertility support should establish three basic institutions that work on prominent issues such as childbirth costs, childcare costs, and fertility and conception problems, strengthening the functions of maternity insurance, universal childcare services, and reproductive health services, and treating them as the three pillars of the future fertility support system.

First, it is necessary to establish a maternity insurance system that meets the needs of China’s population development. This includes improving the maternity insurance system for employees and innovating a maternity insurance system for residents. Second, a universal childcare service system with guaranteed quality, affordable prices, and accessibility is needed. Last, we should create a low-cost and widely beneficial reproductive health service system.

The maternity insurance system needs to further expand coverage. The current one only benefits certain groups of people. In particular, the system fails to guarantee maternity security for flexibly employed and unemployed individuals. According to the average annual salary of urban private sector employees (65,237 yuan) in 2022, and 158-day maternity leave, each woman giving birth can receive a maternity allowance of 28,600 yuan. Based on a conservative estimate that in the future, the annual birthrate will remain steady at 9 million, China’s total annual expenditure on maternity allowances is approximately 250 billion yuan, with approximately 140 billion yuan gap of annual support provided by the national maternity insurance fund.

Taking account of the calculation methods and international criteria for childcare fiscal inputs, as well as the allocation methods for related domestic public service fiscal inputs, childcare fiscal inputs can be divided into a general public budget for childcare construction funds, childcare business funds, and childcare public funds. Among these, the general public budget for childcare business funds is the main fiscal input. 

Option 1: All regions achieve the construction goals for basic childcare services and support kindergartens where conditions permit to set up nursery classes to provide childcare services for infants and young children under the age of three, in accordance with the national fiscal input criteria for kindergartens. The total investment required for infant care centers is estimated to be 25.98 billion yuan, and an annual investment of 54.84 billion yuan in general public budget business funds is also needed. 

Option 2: All regions achieve the construction goals for basic childcare services, and some regions expand the scale of nursery services, in accordance with the national fiscal input criteria for kindergartens. The total investment required for expanded childcare placement construction is 42.01 billion yuan, and an annual investment of 68.70 billion yuan in general public budget business funds is needed for operations. 

Option 3: Basic childcare services are available for all infants and young children, with an enrollment rate based on the average enrollment rate of OECD countries (35%), in accordance to the national fiscal input criteria for kindergartens. The total investment required for infant care centers is 90.10 billion yuan, and an annual investment of 90.77 billion yuan in general public budget business funds is needed. 

Option 4: Basic childcare services are available for all infants and young children, with an enrollment rate referring to the medium to high enrollment rate of OECD countries (50%), in accordance to the national fiscal input criteria for compulsory education. The total investment required for infant care centers is 112.54 billion yuan, and an annual investment of 190.32 billion yuan in general public budget business funds is needed.

There are approximately 240 million couples of childbearing age in China, among which the infertility rate is about 15.5%, meaning about 36.717 million couples are affected by infertility. Of the couples suffering from infertility, 50%-70% actively seek treatment such as IVF, and one-time government assistance for these families can lead to an increase of 3.32 million to 4.65 million births in the coming years. Medical treatment for infertile couples requires central fiscal investment of 28.8 billion to 40.4 billion yuan, which can cumulatively result in 3.32 million to 4.65 million babies. After the diagnosis and infertility treatment are completed, central fiscal investment of about 700 million to 1 billion yuan is needed to support assisted reproductive technology services annually, which can result in an additional 80,000 to 120,000 births per year.

Systemic perspective

Fertility support policies need to be formed using a systemic perspective, with complementary multi-dimensional and multi-level measures to construct a policy system that is broad in coverage, targeted, directionally precise, and diverse in formats. Population development has its own laws and certain inertial characteristics. Improving the low birthrate is a long-term task that China faces requiring continuous policy, financial and human resource inputs. Therefore, the formulation of fertility support policies needs to adhere to the principle of sustainability, ensuring long-term stability in policy implementation.

In the process of constructing a policy framework for fertility support, it is essential to emphasize the inclusiveness of fertility policies and respect the social value of childbirth. First, in terms of population development, we need to integrate the concept of lifecycle services management into fertility support policies. In the process of policy design and improvement, local population size, structure, and changing characteristics should be fully understood to meet the fertility needs of key groups. 

Second, considering individual lifecycle development, we need to coordinate and plan various existing policy resources. It is essential to efficiently link different types of services such as maternal and child healthcare, preschool education, compulsory education, employment services, and elderly medical care to create a complete service chain. 

Third, for family lifecycle development, policymakers need to integrate and optimize various existing service resources. Specifically, services should target the six stages of family development — formation, expansion, stability, contraction, empty nest, and dissolution— and services should include pre-marital examinations, genetic counseling services, maternity leave, infant and child care, health education, housing security, and cultural and sports services, to comprehensively support family development from various dimensions. 

Finally, the fairness of the fertility support policy system cannot be overlooked. Equal access is the key to narrowing the gap between different types of populations. In the future, we can establish a fertility support policy system based on permanent residents rather than household registration populations, improving the convenience and accessibility of fertility support policies.

Shi Yi is from the China Population and Development Research Center; Han Runlin is from the Institute of World Economics and Politics at the Chinese Academy of Social Sciences.

Edited by YANG XUE