Older mothers

The average marriage age of women rose from 22 years in the 1980s to 26.3 in 2020, official data shows. Women are also giving birth to their first child later in life, at the average age of 27.2.

"My observation is that women usually have their first baby at around 30 years of age. The number of second children is rising, but we seldom see women having a third child," said Kang, the hospital president in Shanxi.

"Mothers who give birth a second time are usually older compared to first-timers, which also poses challenges for doctors to ensure their safety," she said.

Kang said guaranteeing safety during pregnancy and preventing birth defects are of great significance as the nation has highlighted the high-quality development of the population.

"It is important to determine whether a child might be born with defects early in the pregnancy through comprehensive tests. With the declining birthrates these days, it is even more important to ensure that each baby born is healthy," she said.

Ji Yong, head of the hospital's neonatal intensive care unit, said that nearly all babies in the province born in critical condition are sent to the facility for treatment.

"Unlike adults, infants cannot express their discomfort and can only cry," she said.

"It is crucial for us to provide meticulous management, special care in incubators, and create a womb-like environment for babies. We weigh them daily, measure their length weekly and monitor their medication intake and physical condition every 12 hours," she said.

Zhang Yanling, head of the obstetrics department at Shanxi Provincial People's Hospital, said that the majority of mothers giving birth at the hospital are aged 30 to 35.

"At our hospital, we rarely see pregnant mothers aged 20 to 25. Those aged 25 to 30 make up around 35 percent, and those aged 30 to 40 account for 43 percent," she said.

Zhang added that more than 70 percent of babies are a mother's first child, while second children make up over 20 percent.

Jiang, the obstetrician in Beijing, said that the proportion of high-risk pregnant women — those aged 35 or older with high blood pressure, elevated blood sugar levels, and other existing illnesses — is on the rise.

"The most significant change lies in the number of pregnant women aged above 40. This morning alone, I received five such cases," he added.

Shen Haiping, deputy director of the National Health Commission's Department of Maternal and Child health, said at a recent news conference that more efforts will be made to carry out pregnancy risk assessments and categorize and manage pregnant women based on their risk levels.

She added it is important to formulate individual treatment plans for at-risk pregnant women.

'Compensatory newborns'

The fertility plans of women of childbearing age in China have remained unchanged despite the announcement of the third-child policy, according to a study released in January by the China Population and Development Research Center and Chinese Academy of Social Sciences' Institute for Population and Labor Economics.

The effects of the second-child policy are also waning, the researchers found.

"Due to the COVID-19 pandemic's suppression of fertility from 2020 to 2022, it is estimated that there will be a certain number of compensatory childbirths from 2023 to 2025, and a slight rebound in the fertility rate and the number of newborns," it said. "But the dominant trend of delaying first marriages and childbirth will continue."

The number of "compensatory newborns" — those born to families who postponed having children due to the outbreak — is expected to be no more than 2 million in total, it added.

Policymakers should focus on the growing average age of people tying the knot and having children for the first time, as well as the rising number of women who never get married and choose to never have children.

A lack of robust fertility supportive policies, delays in first marriages and first childbirths, along with women choosing to remain single and childless "will have a major impact on fertility levels in the future," the study said.

Declining birthrates are affecting many countries around the world, He Dan, director of the China Population and Development Research Center, said in a signed article in March. In 45 countries and regions, fertility rates had dropped to below 1.5 by 2021, while the rate in China dropped to an extremely low level during the pandemic, she said.

The number of children that women of childbearing age considered ideal was 1.86 in 2022, which was 0.7 higher than the actual fertility rate, He said. Difficulties in their lives, unsure expectations for the future, changing social norms on the value of families to contemporary society, and a tendency among couples to take a wait-and-see attitude toward childbearing, accounted for "80 percent of these unmet fertility intentions", she said.

China has launched a string of measures to encourage births, but it will take time for the effects to show and existing measures are insufficient to meet public expectations, He said. She suggested improving basic services in fertility insurance, infant care and nursery care to help couples strike a balance between career development and building a family. Reforms in education, housing and healthcare also need to be advanced to reduce child care costs, He added.