New rules restricting abortions in a Chinese province have prompted concern from citizens and activists over state control of women’s bodies.

Jiangxi province issued guidelines last week stipulating that women more than 14 weeks pregnant must have signed approval from three medical professionals confirming an abortion is medically necessary before any procedure. The measures are meant to help prevent sex-selective abortions, which are illegal in China. The sex of a child is often discernible after 14 weeks.

“Your womb is being monitored,” said one comment on the Weibo microblogging website. “What is the purpose and basis of this policy? The reproductive rights of women in this country seem to be a joke,” said another. One user wrote simply, “The Handmaid’s Tale,” referring to the TV series set in a dystopian future where women’s reproductive functions are tightly controlled by the state.

Jiangxi’s guidelines come as Chinese officials look for ways to deal with the country’s ageing population and low fertility rates, the result of decades of restricting family size, known as the one-child policy.

Loosened restrictions over recent years to allow all parents to have two children has so far failed to resolve China’s demographic problems, which threatens economic growth. The government is considering scrapping limits altogether.

Some worry China’s family planning apparatus will turn its heavy-handed approach to restricting women’s choices.

“People are worried that the government will go from lifting restrictions, to encouraging reproduction, to imposing restrictions on abortion and restricting people’s own decisions,” said Lu Pin, founder of Feminist Voices, a blog on gender issues.

Lu added that many Chinese women, who had chosen not to have a second child despite the new policies, were fearful that strict social policies will be introduced. “There are plenty of signs that show their worries are not unfounded,” she said.

China’s family planning policies have long encouraged the use of abortions, along with contraceptives and sterilisation, as a way to restrict population growth. Since 1971, when the country first introduced limits, doctors have performed 336m abortions, according to government data released in 2013.

In the past, other provinces have implemented similar rules to crack down on aborting female foetuses, a practice that has left China with a massive gender imbalance of 30 million more men than women.

In 2004, Guizhou was the first province to enact such a ban. Other Chinese provinces such as Jiangsu, Hunan, Qinghai, Anhui, Henan, and the city of Shanghai have followed suit with varying restrictions on abortions after 14 weeks.

More provinces are likely to follow Jiangxi’s lead, according to Cai Yong, an associate professor of sociology at the University of North Carolina, Chapel Hill. “In a top-down system, and at a time of tight central control, it is hard for me to imagine this act is a spontaneous one... It definitely signals a major policy change.

Still, Yong doubted whether China would go as far as barring abortions to encourage women to have more children. “Certainly China is capable and has a history of doing that kind of thing but whether it will go all the way to ban abortion … I think that’s a little too far.”

Additional reporting by Wang Xueying