How to get Chinese women to have more children? That is the challenge facing the central government in Beijing as it braces itself for another slowdown in the birthrate. One answer, put forward by the National Health Commission, is to make childbirth less painful.
Currently only a tenth of women get pain relief if they have a natural birth. That compares to more than 85% in the US and the UK, where the most common form of anaesthetic during labour is an epidural.
The issue was thrust into the spotlight in 2017 when a 26 year-old from Shaanxi threw herself out of a hospital window after her in-laws refused her a C-section when she was struggling to deliver.
Indeed, the lack of anaesthesia in natural births is one of the reasons why so many Chinese babies (34%) are delivered by a Caesarean section, which comes with pain relief.
The World Health Organisation recommends the use of this type of surgical intervention in about 15% of cases.
Part of the reason so many Chinese women opt for C-sections is that they only want one child. But as officials nudge families to have more they are also encouraging women to deliver naturally so as to avoid complications in a second pregnancy.
A report published by the Chinese Academy of Social Sciences earlier this month warned that at current fertility rates the Chinese population could peak as soon as 2027. “China’s negative population growth has become unstoppable and research and policy preparation is urgently needed from now on,” it said.
Predictions only a year earlier had the population peaking in 2029 or 2030 at 1.44 billion people. But demographers are now forecasting that the 2018 figures, to be released later this month, will show that births have fallen to pre-2016 levels – when many families were still bound by the One-Child Policy.
“Although the national data on newborns has not been published, local data suggests that births have decreased by between one and two million compared with last year,” the Beijing-based China Times quoted one expert as saying.
Births in 2016 – the first year that every family could have two children – rose by 1.31 million. But in 2017 they declined by 630,000.
Only 10 years ago official government demographers were saying the population would continue growing till 2045, when it would peak at 1.6 billion people.
In those circumstances the government still felt the One-Child Policy was needed. It also meant less reason to provide pain relief for women in labour because pregnancy was still something that was discouraged.
Today even the People’s Daily acknowledges that was a barbaric practice: “Concerns about pain during childbirth are actually concerns about women’s feeling and rights. Promoting painless labour shows greater respect for women’s lives.”
The China Youth Daily weighed in too, adding “pain relief in labour is the mark of a civilised society”.
Yet it will be several years until the majority of women get the epidurals the National Health Commission is now promoting.
Part of the problem is that the spinal injections need to be administered by anaesthesiologists and China only has 79,000 such specialists (one third the number that it needs). Epidurals can also be tricky to administer, meaning it will take time to popularise the practise in China’s risk-averse hospitals.
A second problem is the fact that many Chinese mistakenly believe that epidurals – or any pain relief medication – can lead to mental impairment in the babies that are being delivered.
This belief is particularly common in the older generation.
“The greatest obstacle to getting a pain-free labour is your mother-in-law,” quipped one of the many millions of women who took to weibo after the government announced its pilot scheme in November.
The government is currently drawing up a list of hospitals that will pilot the scheme. By 2020 it is hoped that 40% of deliveries in those institutions will be carried out with the help of an epidural.
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