China’s population growth has been stagnating Description:Visual China Group via Getty Images

A Chinese government policy allowing all couples to have two children led to an additional 5.4 million births in the first 18 months after it took effect.

China’s universal two-child policy, announced in October 2015, was designed to boost the country’s stagnating population growth.

It targeted 90 million women of reproductive age who already had at least one child – 60 per cent of these women were older than 35.


Susan Hellerstein at Harvard University and her colleagues looked at data from two national databases between January 2014 and December 2017, totalling 67.8 million births. The databases covered 28 of China’s 31 mainland provinces.

They measured birth rates from July 2016 to December 2017, the first 18 months after the policy came into effect. The team compared these to baseline birth rates up to the end of June 2016, nine months after the October 2015 announcement.

In the 18-month period, there were 5.4 million additional births to women who already had one or more children. For the first time since the one-child policy, the number of births to women who had previously given birth exceeded that of first-time mothers, accounting for 55.5 per cent of deliveries.

Missing the target

The researchers also reported a 59 per cent increase in births to mothers aged 35 or older. “Preterm delivery rates are generally higher with older women,” says Hellerstein, but the team found no increase in premature births.

Despite the national increase in births, the total births probably fell short of the annual government target of 20 million. “Did the policy relaxation alone result in the number of births that would help reverse demographic trends? It doesn’t look like it from this initial data,” says Hellerstein.

China’s one-child policy was introduced in 1979, with fines imposed for additional children. The policy led to a reduction in birth rates, but exceptions were made for farmers in rural locations as well as for ethnic minorities.

Birth rates declined to a low of 1.49 births per woman in 1999. Driven by concerns about an ageing population and shrinking workforce, from November 2013, a selective two-child policy was introduced: couples were allowed to have a second child if either parent was an only child.

Journal reference: BMJ, DOI: 10.1136/bmj.l4680