Broad-based system needed to boost fertility

China's health minister has highlighted the establishment of a childbirth subsidy system, the expansion of childcare services and ensuring the implementation of maternity leave as key steps to building a birth-friendly society and tackling China's demographic challenges.

The nation's total fertility rate — the average number of babies born to each woman of reproductive age — fell to around 1 last year, and a low fertility trend has persisted for over three decades, said Lei Haichao, minister of the National Health Commission, in an article released by the commission on Thursday.

The rate in China fell below the replacement level of 2.1 children per woman in the early 1990s. It registered a small rebound to 1.75 in 2016 following a policy change that allowed all couples to have up to two children, but then fell again rapidly.

Declining fertility is regarded as a crucial factor that drove a historic fall in China's total population in 2022. The decrease continued to the next year as the nation's total population fell by 2.08 million year-on-year in 2023.

Lei added that last year, the proportion of children age 14 and under accounted for only 16.4 percent of the population, lower than the global average of 25 percent. The ratio of elderly — defined as those age 60 and above — rose to 21.1 percent, proof that China has become a moderately aging society.

"There is an urgent need to improve fertility-supportive policy systems to adjust to new trends in demographic development," he said.

Lei added that the fertility rate is the most significant factor determining future population trajectories. For China, striving for an appropriate fertility level and population size is an essential prerequisite to achieving high-quality demographic development.

The minister said that the central and local governments had dedicated great efforts to tackling demographic challenges in the past decade, such as adjusting family planning policies, strengthening population surveys and launching a string of supportive measures ranging from tax exemptions and maternity subsidies to leave benefits.

He called for a strong sense of urgency to accelerate the formulation of a fertility-supportive policy system that can cover all aspects and be carried out fully.

As varying levels of cash incentives have already been introduced by local governments, Lei said efforts will be made to integrate them and formulate a wide-ranging, basic system aimed at subsidizing childcare.

Families with multiple children will also be given favorable policies in renting or purchasing homes, while medical insurance coverage and tax deductions will be guaranteed, he said.

Ramping up nursery care services is another essential task, with Lei saying that affordable and government-subsidized care facilities will be strengthened, and varied service models — including care centers based at workplaces, communities and homes, as well as full-day care, half-day care or hourly care — should be developed simultaneously.

"Local governments are encouraged to make bold efforts into exploring approaches to guide and support childcare," he said.

Lei added that maternity leave systems should be improved, and employers are encouraged to allow remote working or flexible office hours to help employees balance families and work.

Efforts should also be made to safeguard maternity subsidies, and the implementation of various maternity leave entitlements should be introduced.