The effects of China's universal two-child policy

doi:10.1016/S0140-6736(16)31405-2

The Lancet

Volume 388, Issue 10054, 15–21 October 2016, Pages 1930-1938

https://doi.org/10.1016/S0140-6736(16)31405-2 Get rights and content

Summary

In October, 2015, China's one-child policy was replaced by a universal two-child policy. The effects of the new policy are inevitably speculative, but predictions can be made based on recent trends. The population increase will be relatively small, peaking at 1·45 billion in 2029 (compared with a peak of 1·4 billion in 2023 if the one-child policy continued). The new policy will allow almost all Chinese people to have their preferred number of children. The benefits of the new policy include: a large reduction in abortions of unapproved pregnancies, virtual elimination of the problem of unregistered children, and a more normal sex ratio. All of these effects should improve health outcomes. Effects of the new policy on the shrinking workforce and rapid population ageing will not be evident for two decades. In the meantime, more sound policy actions are needed to meet the social, health, and care needs of the elderly population.

Introduction

In October, 2015, China announced that the iconic one-child policy had finally been replaced by a universal two-child policy. This change is highly significant because, for the first time in 36 years, no one in China is restricted to having just one child. In this Review, we examine the evidence for the potential effects of this shift in policy. The consequences are inevitably speculative, but a body of research has developed that aims to foresee the demographic, health, social, and policy effects of the universal two-child policy. Because much of this research is based on the effects of the preceding policy, we start with an analysis of the impact and controversies surrounding the one-child policy.

Section snippets

The one-child policy

The one-child policy was introduced in 1979 by the Chinese Government who considered population containment as essential to lifting China out of severe poverty caused by decades of economic mismanagement.¹ Between 1950 and 1970, the population had increased from 540 million to more than 800 million.² In response, the government introduced the mostly voluntary later-longer-fewer policy in the 1970s, which encouraged later childbearing, longer spacing between children, and fewer children. This

The introduction of the universal two-child policy

Demographers warned of the negative consequences of the one-child policy almost from the outset.45, 46, 47, 48, 49, 50, 51 Their arguments centred on the fact that the demographic dividend—ie, the accelerated economic growth that results from a decline in fertility and mortality—was reversing. Soon, the negative consequences were beginning to outweigh the positive. The negatives include accelerating population ageing, the skewed sex ratio, and the decline in the working-age population, which

Effects on fertility

The fertility level after the universal two-child policy is a key factor that will affect population growth, the proportion of elderly people, the workforce and economic development, the sex ratio, public health, health systems, and the environment. But the effects of the new policy may be less than expected. There is now clear evidence that the role of fertility policy is diminishing fast, and that fertility in contemporary China, as elsewhere, is socioeconomically determined.8, 11

Surveys of

Population ageing

The universal two-child policy was introduced principally to address the serious challenges of population ageing, one of the greatest challenges for China in the 21st century. However, in the next 20 years the universal two-child policy will have only a marginal effect on the rapid acceleration in population ageing if no other adequate policy actions are taken. Compared with some industrialised countries, where room is very limited for increasing fertility, raising retirement age, and expanding

Conclusion

Since the onset of the one-child policy massive socioeconomic change in China has led to a low fertility culture. The two-child policy will therefore not result in a baby boom, but rather a moderate increase in fertility. But the many negative effects of the one-child policy will disappear and nearly all Chinese people will have their desired family size. The next step, the total removal of the fertility control policy, needs to be considered sooner rather than later.

In short, in the coming

Search strategy

We collected data for this Review from Chinese and English language sources. For work in English, we searched Web of Science, PubMed, and Google Scholar. We searched for Chinese sources from Wan Fan database search engine and the Knowledge Network search engine. Search terms were “one-child policy”, “two child policy”, “population policy”, and “China”. We also searched references from key articles by hand.

References (100)

J Doherty et al.
China's one-child policy: the economic choices and consequences faced by pregnant women
Soc Sci Med
(2001)
X Zhou et al.
The very high sex ratio in rural China: impact on the psychosocial wellbeing of unmarried men
Soc Sci Med
(2011)
X Zhou et al.
High sex ratio as a correlate of depression in Chinese men
J Affect Disord
(2013)
T Cheng
China's little Emperors: Medical consequences of China's one-child policy
Int J Cardiol
(2013)
J Yang
China's one-child policy and overweight children in the 1990s
Soc Sci Med
(2007)
Y Zhang et al.
Who will care for the elderly in China?: A review of the problems caused by China's one-child policy and their potential solutions
J Aging Stud
(2006)
D Su et al.
Depression and social support between China's rural and urban empty-nest elderly
Arch Gerontol Geriatr
(2012)
X Lv et al.
Short form 36-item health survey test result on the empty nest elderly in China: a meta-analysis
Arch Gerontol Geriatr
(2013)
T Hesketh et al.
The one child family policy: the good, the bad, and the ugly
BMJ
(1997)
T Hesketh et al.
The effect of China's one-child family policy after 25 years
N Engl J Med
(2005)

World Population Prospects, the 2012 Revision

G Zhang et al.

Re-examining China's fertility puzzle: data collection and quality over the last two decades

Popul Dev Rev

(2006)

Y Zeng

Options of fertility policy transition in China

Popul Dev Rev

(2007)

S Greenhalgh

Just one child: science and policy in Deng's China

(2008)

Y Zeng et al.

A policy analysis on challenges and opportunities of population/household aging in China

J Popul Aging

(2014)

F Wang et al.

Population, policy, and politics: how will history judge China's one-child policy?

Popul Dev Rev

(2013)

400 million births prevented by one-child policy

F Wang et al.

Demographic dividend and prospects for economic development in China

(2007)

C Hirschman et al.

The path to below replacement-level fertility in Thailand

Int Fam Plan Perspect

(1994)

Trends in maternal mortality: 1990 to 2010

V Fong

China's one-child policy and the empowerment of urban daughters

Am Anthropol

(2002)

M Lee

The one-child policy and gender equality in education in China: evidence from household data

J Fam Econ Issues

(2012)

M Tsui et al.

The only child and educational opportunity for girls in urban China

Gender Soc

(2002)

Numbers of students in formal education by type and level (2013)

(2014)

X Li

The percentage of female CEOs of medium and large companies in China exceeds the average level of the world

Y Zeng et al.

Causes and implications of the recent increase in the reported sex ratio at birth in China

Popul Dev Rev

(1993)

Z Liu et al.

China's excess males, sex selective abortion, and one child policy: analysis of data from 2005 National Intercensus Survey

BMJ

(2009)

S Greenhalgh

Patriarchal demographics? China's sex ratio reconsidered

Popul Dev Rev

(2013)

X Zhou et al.

Depression and aggression in never-married men in China: a growing problem

Soc Psychiatry Psychiatr Epidemiol

(2013)

V Hudson et al.

A surplus of men, a deficit of peace: security and sex ratios in Asia's largest states

Int Sec

(2002)

L Edlund et al.

Sex ratios and crime: evidence from China

Rev Econ Stat

(2013)

T Hesketh et al.

Health effects of family size: cross sectional survey in Chinese adolescents

Arch Dis Child

(2003)

B Yang et al.

Only children and children with siblings in the People's Republic of China: levels of fear, anxiety, and depression

Child Dev

(1995)

DL Poston et al.

Academic performance and personality traits of Chinese children: “onlies” versus others

AJS

(1990)

M Rosenzweig et al.

Do population control policies induce more human capital investment; twins, birthweight and China's on-child policy

Rev Econ Stud

(2009)

Z Jiang et al.

Effects of living conditions on the mental adaptation ability of the new soldiers

China Occup Med

(2002)

Q Li et al.

Study on mental stress, coping style and social support level in the only-child new soldiers

China Occup Med

(2004)

C Li et al.

Analysis of mental health status and its related factors in 1077 new soldiers

Acad J Sec Mil Med Univ

(2004)

X Liu et al.

Survey study on the psychology health conditions of the only-child soldiers

Health Psychol J

(2004)

A Wang et al.

Soldiers' mental health and adaptation ability

China J Health Psychol

(2006)

Wang F. Can China afford to continue its one-child policy? In: AsianPacific Issues: Analysis from the East-West Center....

T Chen et al.

Fragmentation in social security old age benefit provision in China

J Aging Soc Policy

(2015)

Y Xie et al.

Do sons or daughters give more money to parents in urban China?

J Marriage Fam

(2009)

Y Zeng et al.

Older parents benefit more in health outcome from daughters than sons emotional care in China

J Aging Health

(2016)

Y Zeng et al.

Older parents enjoy better filial piety and care from daughters than sons in China

Am J Med Res

(2016)

H Teng et al.

Health status and burden of health care costs among urban elderly in China

Asia Pac J Public Health

(2015)

Z Liang

Suggestions concerning strategies of population and development in the next few decades

J Bongaarts et al.

An alternative to the one-child policy in China

Popul Dev Rev

(1985)

S Greenhalgh et al.

Fertility policy in China: future options

Science

(1987)

JD Gale

The shortcomings and options of China's rural population policy

Chinese Rural Econ

(1994)

Cited by (471)

The influence of demographic structure on residential buildings' carbon emissions in China
2024, Journal of Building Engineering
In the process of advancing China’s carbon peak strategy, the residential building is a crucial sector for carbon mitigation. The energy demand for residential buildings, which is dominated by household consumption, is rapidly rising; coping with aging crisis and reducing carbon dioxide (CO₂) emissions are two major challenges facing China. This study explores the complex relation between demographic structure and residential buildings' CO₂ emissions, and then simulates the future carbon peaking trajectory based on scenario prediction model. The relevant results are fourfold. 1) The overall coupling coordination degree of demographic structure and residential buildings' CO₂ emissions in China has entered the optimal state (i.e. high-quality coordination level) until 2020. 2) The increased household size and proportion of children population from 2010 to 2020 had an inhibitory effect on residential buildings' CO₂ emissions, whereas increased population size and proportion of elderly population had a promotional effect. 3) Under the influence of demographic structure change, peak residential buildings' CO₂ emissions are predicted to be delayed from 2030 to 2032 in China, and the peak value will increase by 3.56%, reaching 1.527 billion tons. 4) At the provincial degree, under the baseline scenario, Beijing will be the first to achieve peak CO₂ emissions in 2026; under the aging scenario, Yunnan and Beijing will be the first to reach peak CO₂ emissions in 2028. This study provides a reference for Chinese policymakers and other countries to incorporate demographic structure into future projections to advance carbon reduction targets' achievement in the building sector.
Association of exposure to multiple heavy metals during pregnancy with the risk of gestational diabetes mellitus and insulin secretion phase after glucose stimulation
2024, Environmental Research
Epidemiological evidence for the association between heavy metals exposure during pregnancy and gestational diabetes mellitus (GDM) is still inconsistent. Additionally, that is poorly understood about the potential cause behind the association, for instance, whether heavy metal exposure is related to the change of insulin secretion phase is unknown.
We aimed to explore the relationships of blood levels of arsenic (As), lead (Pb), thallium (Tl), nickel (Ni), cadmium (Cd), cobalt (Co), barium (Ba), chromium (Cr), mercury (Hg) and copper (Cu) during early pregnancy with the odds of GDM, either as an individual or a mixture, as well as the association of the metals with insulin secretion phase after glucose stimulation.
We performed a nested case−control study consisting of 302 pregnant women with GDM and 302 controls at the First Affiliated Hospital of Anhui Medical University in Hefei, China. Around the 12th week of pregnancy, blood samples of pregnant women were collected and levels of As, Pb, Tl, Ni, Cd, Co, Ba, Cr, Hg and Cu in blood were measured. An oral glucose tolerance test (OGTT) was done in each pregnant woman during the 24−28th week of pregnancy to diagnose GDM and C−peptide (CP) levels during OGTT were measured simultaneously. The four metals (As, Pb, Tl and Ni) with the highest effect on odds of GDM were selected for the subsequent analyses via the random forest model. Conditional logistic regression models were performed to analyze the relationships of blood As, Pb, Tl and Ni levels with the odds of GDM. The weighted quantile sum (WQS) regression and bayesian kernel machine regression (BKMR) were used to assess the joint effects of levels of As, Pb, Tl and Ni on the odds of GDM as well as to evaluate which metal level contributed most to the association. Latent profile analysis (LPA) was conducted to identify profiles of glycemic and C−peptide levels at different time points. Multiple linear regression models were employed to explore the relationships of metals with glycaemia−related indices (fasting blood glucose (FBG), 1−hour blood glucose (1h BG), 2−hour blood glucose (2h BG), fasting C−peptide (FCP), 1−hour C−peptide (1h CP), 2−hour C-peptide (2h CP), FCP/FBG, 1h CP/1h BG, 2h CP/2h BG, area under the curve of C−peptide (AUCP), area under the curve of glucose (AUCG), AUCP/AUCG and profiles of BGs and CPs, respectively. Mixed−effects models with repeated measures data were used to explore the relationship between As (the ultimately selected metal) level and glucose−stimulated insulin secretion phase. The mediation effects of AUCP and AUCG on the association of As exposure with odds of GDM were investigated using mediation models.
The odds of GDM in pregnant women increased with every ln unit increase in blood As concentration (odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.04–2.05). The joint effects of As, Pb, Tl and Ni levels on the odds of GDM was statistically significant when blood levels of four metals were exceeded their 50th percentile, with As level being a major contributor. Blood As level was positively associated with AUCG and the category of glucose latent profile, the values of AUCG were much higher in GDM group than those in non−GDM group, which suggested that As exposure associated with the odds of GDM may be due to that As exposure was related to the impairment of glucose tolerance among pregnant women. The significant and positive relationships of As level with AUCP, CP latent profile category, 2h CP and 2h CP/2h BG were observed, respectively; and the values of 1h CP/1h BG and AUCP/AUCG were much lower in GDM group than those in non−GDM group, which suggested that As exposure may not relate to the impairment of insulin secretion (pancreatic β−cell function) among pregnant women. The relationships between As level and 2h CP as well as 2h CP/2h BG were positive and significant; additionally, the values of 2h CP/2h BG in GDM group were comparable with those in non−GDM group; the peak value of CP occurred at 2h in GDM group, as well as the values of 2h CP/2h BG in high As exposure group were much higher than those in low As exposure group, which suggested that As exposure associated with the increased odds of GDM may be due to that As exposure was related to the change of insulin secretion phase (delayment of the peak of insulin secretion) among pregnant women. In addition, AUCP mediated 11% (p < 0.05) and AUCG mediated 43% (p < 0.05) of the association between As exposure and the odds of GDM.
Our results suggested that joint exposure to As, Pb, Tl and Ni during early pregnancy was positively associated with the odds of GDM, As was a major contributor; and the association of environmental As exposure with the increased odds of GDM may be due to that As exposure was related to the impairment of glucose tolerance and change of insulin secretion phase after glucose stimulation (delayment of the peak of insulin secretion) among pregnant women.
Parental migration, sibling migration, and the educational outcomes of children left behind in rural China
2024, Children and Youth Services Review
In the appearance of massive rural–urban migration in China, there is an increasing number of left-behind children in rural areas. Extensive literature has examined the impacts of parental migration on the educational and cognitive development of rural left-behind children and had mixed findings. However, the influence of sibling migration and the potential channels have been mostly omitted in previous research. This study aims to evaluate the associations between parental and sibling migration experience and rural left-behind children’s educational outcomes through the channels of remittances and children’s time allocation, and explores gender differences in the overall association and particular channels. We utilize data from the 2014 and 2018 waves of the China Family Panel Studies (CFPS) and include 2,313 children aged 10–15 in rural China. We propose a conceptual framework and apply structural equation models to identify the overall effects and channels through which parental and sibling migration experience might affect rural left-behind children’s educational expectations and cognitive test scores. Our results show that sibling migration experience harms rural left-behind children more than parental migration experience, and the negative effects are especially pronounced to girls. Remittance sent back home partially offset the negative effects of parental and sibling migration experience on rural children's educational expectations.
Prenatal exposure to fine particulate matter chemical constituents and the risk of stillbirth and the mediating role of pregnancy complications: A cohort study
2024, Chemosphere
Evidence on the association of fine particulate matter (PM_2.5) exposure with stillbirth is limited and inconsistent, which is largely attributed to differences in PM_2.5 constituents. Studies have found that the hazards of certain PM_2.5 constituents to the fetus are comparable to or even higher than total PM_2.5 mass. However, few studies have linked PM_2.5 constituents to stillbirth. Moreover, the mediating role of pregnancy complications in PM_2.5-related stillbirth remains unclear. To our knowledge, this study was the first to explore the individual and mixed associations of PM_2.5 and its constituents with stillbirth in China. After matching the concentrations of PM_2.5 and its constituents (sulfate [SO₄²⁻], nitrate [NO₃⁻], ammonium [NH₄⁺], organic matter [OM], and black carbon [BC]) for participants according to their geographical location, there were 170,507 participants included in this study. We found that stillbirth was associated with exposure to PM_2.5 and its constituents in the year before pregnancy and during the entire pregnancy, and the associations in trimester 1 were strongest. The risk of stillbirth increased sharply when PM_2.5 and its constituents during pregnancy exceeded the median concentrations. Moreover, stillbirth was associated with exposure to the mixtures of SO₄²⁻, NO₃⁻, NH₄⁺, OM, and BC before and during pregnancy (trimesters 1 and 2). Meanwhile, two-pollutant models also suggested stillbirth was associated with PM_2.5 and its constituents in the year before and during pregnancy. The associations of PM_2.5 and its constituents with stillbirth were stronger in mothers with advanced age and without cesarean delivery history. Additionally, hypertensive disorders in pregnancy, gestational diabetes, and placental abruption mediated the association of PM_2.5 with stillbirth. Therefore, enhanced protection against PM_2.5 for pregnant women before and during pregnancy and targeted interventions for pregnancy complications and anthropogenic sources of PM_2.5 constituents are important to reduce stillbirth risk.
Feasibility analysis of China's medical insurance coverage of assisted reproductive technology
2024, Scientific Reports
Association of the second birth mode of delivery and interval with maternal pelvic floor changes: a prospective cohort study
2024, BMC Pregnancy and Childbirth

View all citing articles on Scopus

View full text

ReviewThe effects of China's universal two-child policy

Summary

Introduction

Section snippets

The one-child policy

The introduction of the universal two-child policy

Effects on fertility

Population ageing

Conclusion

Search strategy

Soc Sci Med

Soc Sci Med

J Affect Disord

Int J Cardiol

Soc Sci Med

J Aging Stud

Arch Gerontol Geriatr

Arch Gerontol Geriatr

The one child family policy: the good, the bad, and the ugly

BMJ

The effect of China's one-child family policy after 25 years

N Engl J Med

World Population Prospects, the 2012 Revision

Re-examining China's fertility puzzle: data collection and quality over the last two decades

Popul Dev Rev

Options of fertility policy transition in China

Popul Dev Rev

Just one child: science and policy in Deng's China

A policy analysis on challenges and opportunities of population/household aging in China

J Popul Aging

Population, policy, and politics: how will history judge China's one-child policy?

Popul Dev Rev

400 million births prevented by one-child policy

Demographic dividend and prospects for economic development in China

The path to below replacement-level fertility in Thailand

Int Fam Plan Perspect

Trends in maternal mortality: 1990 to 2010

China's one-child policy and the empowerment of urban daughters

Am Anthropol

The one-child policy and gender equality in education in China: evidence from household data

J Fam Econ Issues

The only child and educational opportunity for girls in urban China

Gender Soc

Numbers of students in formal education by type and level (2013)

The percentage of female CEOs of medium and large companies in China exceeds the average level of the world

Causes and implications of the recent increase in the reported sex ratio at birth in China

Popul Dev Rev

China's excess males, sex selective abortion, and one child policy: analysis of data from 2005 National Intercensus Survey

BMJ

Patriarchal demographics? China's sex ratio reconsidered

Popul Dev Rev

Depression and aggression in never-married men in China: a growing problem

Soc Psychiatry Psychiatr Epidemiol

A surplus of men, a deficit of peace: security and sex ratios in Asia's largest states

Int Sec

Sex ratios and crime: evidence from China

Rev Econ Stat

Health effects of family size: cross sectional survey in Chinese adolescents

Arch Dis Child

Only children and children with siblings in the People's Republic of China: levels of fear, anxiety, and depression

Child Dev

Academic performance and personality traits of Chinese children: “onlies” versus others

AJS

Do population control policies induce more human capital investment; twins, birthweight and China's on-child policy

Rev Econ Stud

Effects of living conditions on the mental adaptation ability of the new soldiers

China Occup Med

Study on mental stress, coping style and social support level in the only-child new soldiers

China Occup Med

Analysis of mental health status and its related factors in 1077 new soldiers

Acad J Sec Mil Med Univ

Survey study on the psychology health conditions of the only-child soldiers

Health Psychol J

Soldiers' mental health and adaptation ability

China J Health Psychol

Fragmentation in social security old age benefit provision in China

J Aging Soc Policy

Do sons or daughters give more money to parents in urban China?

J Marriage Fam

Older parents benefit more in health outcome from daughters than sons emotional care in China

Review
The effects of China's universal two-child policy