Shanghai: In a significant move to address declining birth rates, Shanghai has added a dozen types of Assisted Reproduction Technology (ART), including in vitro fertilization (IVF), to its basic health insurance. This initiative aims to alleviate the financial burden on infertile couples seeking costly fertility treatments.

The latest measure, implemented on June 1, 2024, in provinces such as Jiangsu, Qinghai, Zhejiang, and Jiangxi, underscores China’s commitment to reversing its declining birth rate. Last year, six other provincial-level regions, including Beijing, had already incorporated ART into their basic health insurance. In Jiangsu, 35 facilities will now offer reimbursed ART services, ranging from sperm extraction to IVF.

China's population fell for the second consecutive year in 2023, with the total number of people dropping by 2.08 million, or 0.15%, to 1.409 billion. This decline surpassed the 850,000 population decrease in 2022. New births fell by 5.7% to 9.02 million in 2023, resulting in a record low birth rate of 6.39 births per 1,000 people, down from 6.77 births in 2022.

Under the new ART coverage, basic health insurance will cover at least 50% of fertility treatment expenses. In Shanghai, where hospitals receive 100,000 ART patient visits annually, this coverage is expected to save each patient about 9,000 Yuan. The cost of an IVF or intracytoplasmic sperm injection (ICSI) cycle in Shanghai averages around 30,000 Yuan (US$4,220).

The reduction in ART expenses is anticipated to increase access to fertility treatments for more couples, especially in large cities where the birth rate is particularly low. The National Healthcare Security Administration (NHSA) issued guidelines in June 2023 to regulate fertility treatment pricing, ensuring hospitals provide ART at government-set or lower prices.

Following the government’s decision, Chinese stocks linked to reproductive health and infant care saw a rise. Jianxin Fertility Group Ltd. (Hong Kong) increased by 4% in morning trading on July 2, while Annil Co, a children's apparel maker, rose by 6.2% onshore. The inclusion of ART in health insurance is expected to make fertility treatments more accessible, particularly for couples facing reproductive challenges.

China's infertility rate has risen from 2% in the 1950s to 18.5% today, with one in eight couples of reproductive age requiring ART. In Beijing, ART has been covered by basic health insurance since July 2023, benefiting 32,000 patients by the end of March 2024 at a total expense of 280 million Yuan, 190 million of which was covered by insurance.

Some patients have postponed ART procedures until they were included in basic health insurance. Additionally, China has added various fertility medications to its national reimbursement drug list. The government has also introduced several initiatives to encourage childbearing, including relaxing the one-child policy, offering financial incentives, extending maternity leave, and providing child support.

Despite these efforts, the government continues to struggle with motivating citizens to have children amid economic concerns, high child-rearing costs, and workplace pregnancy discrimination. Many Chinese women delay marriage and choose not to have children due to financial constraints and career priorities. The average cost of IVF in cities like Shanghai ranges between $4,500 to $5,000, making health insurance coverage crucial in reducing these expenses.

In July 2022, 17 Chinese authorities issued guidelines for including appropriate labor pain management methods in health insurance. As of June 2021, China had 539 ART-approved medical institutions and 27 sperm banks, conducting over one million IVF cycles annually. Experts from the National Clinical Research Centre for Obstetrics and Gynecology highlighted the critical role of ART in addressing China's population decline.

China's population fell for the second consecutive year in 2023, with just over 9 million babies born, the lowest number since the founding of the People's Republic in 1949. The recent court verdict in favor of Teresa Xu, an unmarried woman denied egg freezing, and proposals to grant single and unmarried women access to fertility services, reflect growing awareness of reproductive rights.

China faces intertwined challenges of declining birth rates and an aging population. Over the next decade, more than 300 million people aged 50 to 60 will leave the workforce, equivalent to the population of the United States. The declining birth rate, exacerbated by policies like the one-child policy and economic slowdown, presents a significant socio-economic challenge.

Current population projections may underestimate the extent of these challenges, as assumptions of a fertility rate rebound remain shaky. China's rapid societal aging demands urgent attention and practical governance solutions. The inclusion of ART in basic health insurance is a step towards addressing these demographic issues.