In Depth: The Hidden Crisis of China’s Boom in Premature Births

Yangyang, born at just 25 weeks and weighing only 0.8 kg, is one of the rare surviving premature babies in China, a country where 10.6 million babies were born that year. His early life was characterized by severe medical complications such as respiratory distress and intracranial hemorrhage, requiring intensive neonatal care. The daily NICU costs exceeded 10,000 yuan ($1,433), causing significant emotional and financial strain for his family, but they persevered as long as there was hope. Yangyang’s story reflects a growing phenomenon in China, where advances in medical care let more premature infants survive, yet these children and their families face daunting odds and enormous burdens [para. 1][para. 2][para. 3].

Premature births are increasing in China even as overall birth rates decline. From 2017 to 2022, the preterm birth rate rose from over 5.1% to nearly 6.6%, and early preterm births climbed from over 1.3% to 1.4%, according to a 2025 Peking University study. The total birth rate fell from 13.38 per 1,000 people in 2001 to 6.77 per 1,000 in 2024, with only 9.5 million births that year. Thus, while fewer babies are born, a higher proportion start life with grave health challenges. Aging mothers, the prevalent use of assisted reproductive technologies, and more families having second and third children are all factors driving preterm birth rates higher, compounded by high societal stress [para. 4][para. 5][para. 6].

Advancements have improved survival: guidelines in 2024 report that over 80% of extremely premature infants (born at/after 26 weeks) now survive, although regional gaps persist. A Shandong study found that 74.1% of deaths among nearly 1,200 extremely premature infants resulted from withdrawal of medical care by families, commonly due to a bleak prognosis or lack of resources. Decision-making remains complex, as families weigh living with long-term disability against spiraling financial and emotional costs [para. 7][para. 8][para. 9][para. 10][para. 11][para. 12][para. 13][para. 14][para. 15][para. 16][para. 17][para. 18][para. 19].

Some risks, such as bronchopulmonary dysplasia—a chronic lung disease from prolonged ventilation—emerge as a result of advances keeping the smallest infants alive. Gastrointestinal emergencies like necrotizing enterocolitis are also prevalent. The decision to continue treatment often comes with warnings from doctors about the possibility of devastating health and financial consequences (“ren cai liang kong,” meaning the loss of both person and financial means). Survival does not guarantee healthy futures; many endure lasting health issues [para. 10][para. 11][para. 12][para. 13][para. 14][para. 15][para. 16][para. 17][para. 18][para. 19][para. 20].

China’s historically high threshold for medical intervention—28 weeks or 1,000 grams, compared to 24 weeks in some countries—means many of the most fragile newborns are not aggressively treated. Recent guidelines urge proactive care from 26 weeks onward and encourage case-by-case treatment from 24 weeks if families agree [para. 21][para. 22].

Surviving parents fight battles on three fronts: financial, practical, and emotional [para. 23]. Nearly 41% of families earn below 50,000 yuan a year, yet half face total medical fees between 100,000-200,000 yuan, and 87% pay catastrophic health expenditures (over 40% of the household’s capacity). Long-term care after NICU remains a challenge, with parents struggling to provide complex care at home, often without adequate guidance [para. 24][para. 25][para. 26][para. 27][para. 28][para. 29].

Hospitals are starting to implement family-integrated NICU care and transitional wards, but these remain rare. Social support is insufficient—most families lack ongoing psychological or resource support. Charity organizations, such as the Chunmiao Foundation, try to bridge the gaps but are overstretched [para. 30][para. 31][para. 32].

Experts call for a coordinated national network connecting prenatal care, hospital intervention, and community support. Some regions, like Fujian, offer provincewide emergency transfers free for residents, but elsewhere families must navigate inconsistent systems and prohibitive costs. Follow-up care is another weakness, especially for rural families unable to access city hospitals [para. 33][para. 34][para. 35][para. 36][para. 37][para. 38][para. 39][para. 40][para. 41][para. 42][para. 43][para. 44][para. 45].

Ultimately, building a robust rescue and support network for China’s premature infants demands systemic reforms, dedicated funding, and sustained attention to both medical and psychosocial needs [para. 46][para. 47][para. 48][para. 49][para. 50][para. 51][para. 52][para. 53][para. 54][para. 55][para. 56][para. 57][para. 58][para. 59][para. 60][para. 61].