Shanghai adds ART services to medical insurance scheme amid China’s population woes

A fertility rate of 2.1 is known as the replacement rate, and is generally regarded as necessary to guarantee a broadly stable population.

The figure from Shanghai, the first city in mainland China to enter the ageing society when its share of residents aged 65 and above topped 14 per cent in 2017, is well below that for South Korea, a country known as having the world’s lowest fertility rate of 0.72 last year.

China’s total fertility rate last year was not disclosed by authorities, but estimated by analysts to be about one.

The fertility rate in Hong Kong was estimated at 0.8, the United Nations Population Fund said in April.

The problem of a low birth rate is set to accelerate China’s ageing population, which in turn increases the social dependency ratio, strains the social security system, pushes up government debt and hurts social innovation and entrepreneurship in the already slowing economy, according to a report issued by the Beijing-based Yuwa Population Research Institute on Tuesday.

“This is an outcome we have to endure [for the decades of family planning policy],” said Hu Zhan, a professor of demography at Fudan University.

“The problem is, even if the fertility rate rises, there will still be fewer babies because we’re having a decreasing number of women at childbearing age thanks to the one-child policy.”

The rapid drop in newborns has already hit preschools across China, as the number of kindergarten teachers fell by over 170,000 last year, representing the first drop since 2010, according to a report issued by the Beijing-based Sunglory Education research institute.

“The decline in the number of children came so fast that it brought a roller coaster experience for the preschool education industry,” said Zhang Shouli, the institute’s founder.

The number of children at preschools between 2026 and 2030 is set to halve compared with 2020, he projected.

But the policy shift does not seem to have helped, as more people have delayed marriage and remain hesitant over having children amid increasing costs, diversified lifestyles and a feminist awakening.

And as traditional culture that once praised motherhood and emphasised love for children has diminished, China needs a friendlier social environment for families with children, added Hu from Fudan University.

“The loosening of birth policies and follow-up incentives won’t bring a big change to the absolute number in births,” he said.

“The point is that society needs to show more tolerance towards mothers and children, so a soft landing for China’s demographic shift would be possible.”