As China Limits Vasectomies, Many Ask What’s Next

China’s government has been warning about limited supplies of everything from energy to poultry this winter. But another shortage has lately raised some more existential concerns: Vasectomies are increasingly hard to come by.

Large public hospitals in China’s biggest cities have stopped offering the procedure, or are restricting it to married men with children, according to a recent report in the Washington Post. No formal policy exists on the matter. But thanks to China’s rapidly falling birthrate, and the government’s avowed determination to reverse it, physicians and hospital administrators are taking the hint.

For now, it’s little more than an inconvenience; the procedure is still available in many areas, and outright restrictions on reproductive freedom aren’t likely any time soon. But it’s slowly dawning on young Chinese that the government sees its version of family planning as a solution to a declining population — and that they can no longer take for granted their right to not procreate.

In China, family planning has long been directed by the government. Two millennia ago, the imperial state mandated early marriages and simplified, low-cost ceremonies to boost birth rates devastated by war. One emperor went so far as to impose a tax penalty on unmarried women. Neither time nor a proletarian revolution eliminated this impulse. In the 1950s, the challenge of lifting a massive population out of poverty convinced Mao Zedong that China needed to restrain its birthrate. In 1957, he proposed a 10-year national birth-control program, saying, “It’s not OK to have human reproduction in a state of total anarchy. We need birth planning.”

Fourteen years later, Mao’s government set a target of reducing the annual rate of population growth from 2.5% to 1% in cities, and to 1.5% in rural areas. By the end of the decade, it lowered those targets to 0.6% in the cities and 1% in the country. The One Child Policy, starting in 1979, was intended to ensure that population growth didn’t outpace all-important economic growth. Implementing the policy was generally left to local governments, which often used threats and coercion — including forced sterilizations and abortions — to meet their targets.

From its earliest days, the policy was meant to be temporary. But discussion about how to end it only grew serious in 2012, when China’s working-age population declined for the first time. The government, suddenly fearful that a shrinking and aging workforce could lead to reduced productivity, higher health-care costs, and more social tensions, moved quickly. It implemented a two-child policy in 2016 and, when that didn’t boost fertility, a three-child policy in 2021. Despite these efforts, the demographic outlook doesn’t look much better.

Perhaps inevitably, policy makers are now turning to family planning. In 2018, one of China’s most impoverished provinces announced that women who wanted an abortion after the 14th week of their pregnancies needed to have the written approval of three professionals declaring the procedure “medically necessary.” The move was intended to reduce sex-selective abortions, but many social-media users saw it as an infringement on women’s rights.

No other government unit has yet followed suit, perhaps fearing a backlash. But that careful approach may not last. In September, China’s state council issued a 10-year planning document notionally devoted to boosting the prospects of women. Buried deep inside was a single-sentence pledge: “Reduce medically unnecessary abortions.” No explanations or further details were provided, leaving local governments and health-care facilities to figure out what to do on their own — not unlike how many of them navigated population-control targets.

For years, China’s top leaders have called for boosting fertility without specifying how. In the absence of direction, individuals have improvised. “The fundamental policy is that China needs more childbirths,” a hospital administrator who’s chosen to limit vasectomies told the Washington Post. The outcome, in his case, is less access to a form of family planning that Chinese couples long took for granted. In a country where “family planning” is synonymous with population control, that’s a bleak hint of the future.