In Depth: Maternity Wards Are Latest Victim of China’s Falling Birthrate

China’s hospital maternity wards are suffering from a record-low birthrate, leading to widespread closures and downsizing. As of March, at least 35 public medical institutions had ceased delivering newborns over the past three years, with 10 closures in the first quarter of this year alone [para. 1][para. 2]. These numbers likely underestimate the real extent, as several hospitals in Shanghai and Guangzhou have reportedly shuttered their maternity departments without publicizing the closures [para. 3]. The rate of closures has accelerated since 2023, coinciding with China’s population decline and a sharp drop in birthrates. Many maternity departments or specialized hospitals are struggling, reducing bed counts or diversifying their services to stay in business. This bleak outlook is driving more obstetricians to leave the field [para. 4].

The significance of the issue was highlighted in February when Duan Tao, director of obstetrics at Shanghai First Maternity and Infant Hospital, went public with a plea to save obstetrics, raising alarms about the future of care for women and babies during pregnancy, childbirth, and the postpartum period [para. 5]. Li Li, an obstetrician from Inner Mongolia, expressed concerns that obstetric services are in danger of disappearing in some regions entirely [para. 6]. A senior doctor warned that with maternal and neonatal mortality rates being a core indicator of a country’s developmental level, the crisis in obstetrics could have broader implications for China [para. 7]. The National Health Commission (NHC) responded with a circular requiring institutions planning to close maternity wards to consult widely with patients and authorities, emphasizing continued support for maternal and child health [para. 8][para. 9].

Following a brief baby boom in 2016 after the relaxation of the one-child policy, China has seen a year-on-year decline in newborns even after allowing three children per family in 2021. The population fell for the first time in 60 years in 2022, with birthrates hitting record lows [para. 12]. Duan attributed this to a general lack of willingness among the childbearing-age population, especially in large cities where high housing costs, educational pressures, and unfavorable fertility environments reign [para. 13][para. 14]. The high costs and low birthrates are severely straining maternity departments; for instance, larger hospitals need at least 1,000 deliveries annually to sustain their operations [para. 15].

As of early 2023, approximately two dozen medical institutions have announced discontinuation of obstetrics services [para. 17], with hospitals reducing bed numbers to cut costs [para. 21]. Shanghai First Maternity and Infant Hospital, a leading facility, has seen deliveries decline significantly from their peak in 2016 [para. 24]. Private hospitals face even tougher challenges as they struggle more without state subsidies, with some closing due to financial pressures from the pandemic [para. 29].

In response, some hospitals are diversifying their operations, such as providing daycare centers or VIP services to maintain viability [para. 30]. Yet, the financial structure of doctors' incomes, heavily tied to the number of deliveries, is causing many obstetricians to leave the field due to low bonuses that do not compensate for their high-risk and high-intensity work [para. 38][para. 39].

The exodus of obstetricians is worrying as it may threaten maternal health and undermine efforts to increase the birthrate. Older maternal ages and increased use of in vitro fertilization contribute to higher risks, making obstetric services even more essential [para. 43][para. 45]. Policymakers are called upon to support the development of obstetrics, including improving doctors’ salaries and incentivizing childbirth [para. 48].