Against the backdrop of China’s declining population, issues related to childbirth have become a major focus for delegates and members at this year’s “Two Sessions” (the National People’s Congress and the Chinese People’s Political Consultative Conference). Especially, the concern is about how to help older unmarried women who desire to have children but haven’t done so.

Xu Congjian, a member of the National Committee of the Chinese People’s Political Consultative Conference (CPPCC) and the director of the Obstetrics and Gynecology Department at Fudan University’s affiliated hospital, proposed allowing unmarried women, under specific conditions, to preserve their fertility when they reach a certain age without being able to conceive. He suggested that these women could preserve their fertility until the conditions for assisted reproductive technology (ART), such as IVF, are met.

Conditional Opening of Egg Freezing for Unmarried Women

The term “fertility preservation” refers to the technique commonly known as “egg freezing,” while ART generally encompasses procedures like in vitro fertilization (IVF). According to the “Report on the Progress and Prospects of Maternal and Child Health in China 2019,” China faces a significant issue of infertility, with an infertility rate as high as 10%-15%, affecting nearly 50 million people. The demand for corresponding ART procedures continues to rise.

Currently, the “Regulations on Human Assisted Reproductive Technology in China” stipulate that ART should not be provided to couples or unmarried women who do not meet the regulations and guidelines of the National Population and Family Planning Law.

Xu Congjian argues that this regulation should take into account special circumstances where women are facing difficulties in achieving their desire for parenthood. He gives examples, such as unmarried women suffering from medical conditions that affect their fertility (such as endometriosis, which has a high incidence of 10%-15% among women of childbearing age) or diseases that can impact fertility (such as leukemia and its treatment). Also, there could be specific environments affecting fertility that unmarried women may need to work and live in during a certain period before marriage.

“These issues regarding the future fertility of unmarried women should receive attention and support from society,” Xu Congjian stated.

To address this, Xu Congjian recommends that regulations concerning ART need to be updated as necessary. They should allow unmarried women who meet certain medical criteria or specific conditions to preserve their fertility as needed. After fulfilling the requirements for parenthood, the further steps of ART can be determined based on individual circumstances.

However, since ART involves not only medical issues but also complex social and ethical considerations, Xu Congjian emphasizes that the “egg freezing” for unmarried women should not be fully open without any constraints to avoid sending the wrong message to society.

He suggests that unmarried women who undergo medical assessments indicating a decreasing trend in their fertility (specific criteria set by medical experts) and have a strong desire for parenthood could consider preserving their fertility. This should be done with medical guidance and fertility planning. Moreover, each case of fertility preservation for unmarried women should be discussed and approved by an ethics committee and medical management authorities based on their “specific conditions” and individual health. An assessment of their physical condition, their ability to raise children, and their personal preferences should also be conducted before further ART measures are allowed.

Promoting ART Coverage in Healthcare Insurance

Xu Congjian is not the only CPPCC member who has recognized the needs of unmarried women regarding fertility. Ge Junbo, a member of the National Committee of the CPPCC and an academician of the Chinese Academy of Sciences, suggests addressing the issue of older women missing their prime childbearing years by increasing the availability of qualified fertility assistance institutions, including sperm banks and egg banks, for people of childbearing age to store high-quality sperm and eggs. This support is intended to help families facing difficulties in conceiving and to enhance the healthcare protection for individuals at a higher risk of reproductive issues due to delayed childbearing.

Lu Weiying, a CPPCC member and the chief expert at the Reproductive Medicine Center of Hainan Women and Children’s Medical Center, submitted a proposal during this year’s “Two Sessions” advocating for allowing single women to freeze their eggs. She emphasized that this does not mean advocating blind egg freezing and stressed that promoting reproductive health education, encouraging age-appropriate marriage and childbearing, and promoting eugenics and maternal and child health remain crucial areas of focus.

Recently, the National Healthcare Security Administration’s news about gradually including ART procedures in healthcare insurance coverage has drawn industry attention. Lu Weiying believes that if infertility diagnosis and treatment services could be included in healthcare insurance at an earlier stage, it would reduce the medical costs for families dealing with infertility. This would make it more accessible for infertility patients, especially those from economically disadvantaged backgrounds, to seek ART treatments.

However, the specific details of these regulations are yet to be clarified. Key issues to be determined include the eligible age groups for healthcare insurance, the number of assisted reproductive cycles covered, the pricing of healthcare insurance for medications, surgical procedures, and laboratory cultivation, among other factors.

Reproductive medicine expert and academician of the Chinese Academy of Sciences, Huang Hefeng, previously stated in an interview with financial media that including ART procedures in healthcare insurance would significantly alleviate the medical burden on families struggling with infertility. It would enable more infertility patients, especially those from economically challenged households, to access ART treatments.

These proposals from CPPCC members come at a time when China’s population has experienced its first decrease in 60 years, with the country’s birth rate hitting a historic low in the past year at 6.77 births per thousand people. Some CPPCC members have also suggested measures to implement the “three-child” policy, including providing free university education, extending maternity leave, and strengthening financial and tax incentives, as well as housing subsidies for women and families with three children, to boost their desire to have more children.

Simultaneously, to boost the birth rate and promote healthy reproduction while preserving fertility, experts emphasize the need for effective adolescent sex education, reducing unintended abortions, encouraging timely childbearing to avoid unnecessary delays, protecting reproductive environments, addressing the ongoing decline in male semen quality, promoting healthy lifestyles, and advising couples to seek reproductive health consultation before pregnancy to facilitate eugenics and healthy childbirth.