In need of a baby boom, China clamps down on vasectomies

Zhao Zihuan, a first-time mother in the Chinese city of Jinan, had two miscarriages before giving birth to a son last year. After seven hours of labor, the emergency Caesarean was performed.

Exhausted by child care, the 32-year-old and her husband decided one kid was enough — so in April they began to inquire about a vasectomy. Two hospitals turned them down. Zhao’s husband was told by one doctor that surgery is not allowed in the new country’s family-planning laws.

“I was frightened and angry at the same time,” said Zhao, who works in publishing. What if I get pregnant accidentally? The burden will be too great. The burden will be too great.”

For more than three decades, Chinese authorities forced men and women to undergo sterilization to control population growth. Now, as the government tries to reverse a plummeting birthrate that it fears could threaten social stability and the economy, hospitals are turning away men seeking vasectomies.

“It’s a rather simple surgery in theory, but public hospitals will almost always turn patients away because we are aware of the risks involved in doing something that’s not explicitly okayed by the government,” said Yang, the director of a hospital in Jingzhou city, Hubei province, who gave only part of his name for fear of punishment for speaking to foreign media. “The fundamental policy is that China needs more childbirths.”

China recorded 8.5 births per 1,000 people in 2020, the lowest rate in more than 70 years, according to official data released in November. With one of the world’s lowest fertility rates — at 1.3 children per woman, it is below Japan’s — demographers predict China’s population could begin to fall within a few years.

Yet efforts to arrest the trend — including loosening family-planning rules such as the former one-child policy, and offering cash subsidies and longer parental leave to encourage larger families — have failed as more Chinese couples choose not to have children.

Chinese family-planning law says citizens’ reproductive rights, including choosing birth control, are protected. Although there is not an official ban on surgery or any restrictions, hospitals and doctors performing vasectomies must be licensed by the county’s health department. Faxed questions were not answered by the National Health Commission.

The worry for some couples is that authorities could turn to more forceful or restrictive measures akin to those used to enforce the one-child policy. Guidelines released by the State Council in September said local governments should try to reduce the number of abortions for “nonmedical reasons.”

Twelve public hospitals contacted by The Washington Post, including facilities in Shanghai, Beijing and Guangzhou, said they no longer offered the procedure. While six hospitals claimed they continue to perform the procedure, one hospital stated that it is no longer offered for unmarried men.

Couples and single men who sought the procedure said doctors and hospital staff refused, telling them they would regret the decision later. Some requested documentation to prove that they were married and proof that the couple had had children prior to proceeding with surgery.

Zhou Muyun, a 23-year-old copywriter in Guangzhou, tried unsuccessfully to get a vasectomy this year. Han Feifei was a mass communication graduate student. He moved in with his girlfriend and wanted to keep a DINK lifestyle — double income and no children.

“The more I learn about vasectomies, the surer I feel about my decision. Zhou stated that we want to have sexual relations, and not children. He also noted the fact that vasectomies are less complicated than male sterilization.

Zhou was turned down by two hospitals, with doctors telling him that he was too young.

“Having a child or not is our choice to make and our fundamental right. He said that we don’t have to be told how to live by anyone.

During the one-child-policy era, vasectomies were often seen as taboo in China. They were less common in certain provinces like Sichuan and Henan where the government pushed for it more.

As the government loosened family-planning rules, the number of vasectomies performed fell from 149,432 in 2015 to 4,742 in 2019, according to official data. China implemented a two-child policy in 2016.

“With the three-child policy in place, doctors have new, longer-term concerns. Sun Xiaomei from China Women’s University, Beijing said that performing surgery on a woman in a family-oriented community means they are deprived of their chance to have children or grandchildren. “No one wants to be blamed for that.”

After the three-child policy was announced, Zhao and her husband felt a greater sense of urgency to get his vasectomy done, fearing further restrictions on abortion or access to contraceptives.

Jiang, 30, who works in customer service at an Internet company, visited six hospitals in his home province of Fujian before finding one more than 1,200 miles away in Chengdu in Sichuan province that would perform a vasectomy. He posted details of the clinic on the internet after his March surgery. However, another user informed him that the hospital no longer offers the procedure.

“I felt like I had finally gotten rid of this huge burden,” said Jiang, who did not disclose his full name out of security concerns for criticizing government policy. “Those around me who are married and have kids have nothing that makes me envious.”

The discouragement of vasectomies reflects traditional views that women should bear the burden of birth control. Zhou asked his doctor about a vasectomy. He suggested his girlfriend use an intrauterine device.

“This reflects a long patriarchal tradition,” said Yue Qian, an associate professor of sociology focusing on gender and demography in China at the University of British Columbia. “Men are never put at the center for issues related to marriage, family, fertility and birth control.”

That may be changing. A popular online personality, Yuan Fang, a teacher in Zhejiang province who comments on family and gender issues, took to the video-streaming platform Bilibili in October to describe his experience getting a vasectomy.

Zhao and her husband eventually found a doctor at a smaller public hospital outside Jinan that would perform the procedure. The doctor discouraged him even from getting on the operating room table.

“I already said I want to do it. Zhao’s husband said that he was doing it. Declining to give his name out of privacy concerns, he added: “In the end it’s us, not the government, that has to bring up a child.”

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