China announced plans to discontinue its “one-child policy” in October, relaxing over three decades of controversial family planning policies and changing to a universal two-child policy. This new policy is a step forward, but China’s population aging and gender imbalance will create challenges for decades, according to a leading Stanford health researcher.

“China has reached a certain level of social and economic development where low fertility and population aging have become norms,” said Karen Eggleston, a senior fellow in the Freeman Spogli Institute (FSI) and director of the Asia Health Policy Program. “Similar trends are seen in Japan and South Korea, and governments are struggling to catch up.”

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The policy change comes amid concerns of potential labor shortages and a burgeoning aging population that could pressure the Chinese economy for years to come. 

The country has had record growth – China’s GDP growth rate averaged 8.6 percent over the past five years – which is now slowing. That trend coupled with China’s rising life expectancy reinforces the need for a healthy, economically productive population to support the elderly, experts say.

“Demographers who study China knew a policy change was coming, but not when,” said Eggleston. “The policy was strategically announced with the Five Year Plan – a sort of developmental roadmap for the country.”

A forthcoming book, Policy Challenges from Demographic Change in China and India, edited by Eggleston examines the policy challenges posed by demographic change in China and India, from family planning to social pensions systems that support the elderly. One chapter looks exclusively at population policy, sex ratio and fertility in China.

A spur to action?

A shift to a consistent, nationwide two-child policy is a step in the right direction, Eggleston said, and it is unlikely to translate to a boom in the birthrate.

Some areas of the country and specific couples already enjoyed a two-child policy due to local policy differences and an earlier national policy easing. In 2013, the Chinese government allowed couples with a husband or wife from a single-child family to have a second child.

Chinese cities that never had a one-child policy to begin with, like Hong Kong and Macau, have very low fertility. A recent article in China Journal noted that, despite the ubiquity of the one-child policy campaign, China’s rapid economic development since 1980 deserves the “lion’s share of credit” for reduced births as the country’s total fertility rate has declined.

“The real question is how responsive the Chinese will be,” Eggleston said. “It’s not clear that there will be a noticeable response in the short or medium-term.”

Implementation of the policy will take time, but China will work “quite expeditiously” to apply such policies so that people’s expectations are met. Alongside legal change of China’s varying local policies, it’s expected that China will employ several public education campaigns and its cadre of family planning staff as conduits for disseminating the new national policy, Eggleston said.

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A 1986 poster highlights China's one-child policy.

Credit: Flickr/Collection Stefan R. Landsberger, International Institute of Social History (Amsterdam).

But other factors are at play, too, such as urbanization and changes in labor force participation.

“Young and middle-aged couples will be thinking twice about having another child because of education expense, job demands and the need to support aging parents,” Eggleston said.

A paper published by Eggleston and three other scholars in the Journal of Labor & Development analyzed how employment of females from rural areas affected fertility, using data from a survey of 2,355 married women in China. The survey examined “off-farm” employment, which was defined as travel to another village, town or city for work.

The researchers found that off-farm employment for those women reduced the probability of having more than one child by 54.8 percent and the probability of preferring more than one child by 49.6 percent. An earlier blog piece on VoxEU highlighted those research outcomes.

Another aspect of China’s demographic change is gender imbalance. Male preference has long been a cultural factor in China and, with the pressures of the one-child policy, a cause behind its skewed population.

That reality will not dramatically change soon, Eggleston said. Even if the end to the one-child policy brought the sex ratio at birth back to normal levels, the existing imbalance of the younger population will create millions of “forced bachelors” among poorer men who cannot find brides, as well as a whole set of related issues.

Choice restored

What the policy assuredly does, though, is remove a barrier. Many Chinese women who before did not have the opportunity to give birth to a second child, now have that opportunity.

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“This is a crucial arena of choice restored to the Chinese,” Eggleston wrote of the 2013 policy relaxation in a brief presented at the Federal Reserve Bank of Kansas City.

Previously, the absence of such a freedom led some couples to face substantial fines from the government, depending on the local variation of the one-child policy.

“Regardless of the new policy, demographic trends point to the importance of investing in child education, nutrition and skill development,” Eggleston said.

A similar message is carried in a chapter in Policy Challenges, co-authored by Sanghyop Lee and Qiulin Chen, who suggest that putting resources toward human capital development – education and health – can offset the destabilizing effects of demographic transition.

Research being done by FSI’s Rural Education Action Program led by Stanford professor Scott Rozelle works to directly inform education, health and nutrition policy in China.

Spending more on education – particularly for women and girls – is win-win. It complements pro-employment policies, and boosts productivity for women and the economy as a whole, Eggleston said.

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Triyana will focus on analyzing the effects of rural-urban migration on children’s health outcomes in China and Indonesia, contributing valuable insight toward Shorenstein APARC’s research initiative on demographic change in Asia.

Currently an Indonesia Research Fellow at the Ash Center for Democratic Governance and Innovation at Harvard University, Triyana is also completing her doctoral degree from the Harris School of Public Policy at the University of Chicago. She holds a BA and an MA in economics, and a BS in mathematics, all from the University of Chicago.

The Shorenstein Asia-Pacific Research Center and its Asia Health Policy Program have joined with other centers and programs across the university as collaborative partners for the new Stanford Center for Population Research (SCPR). Supporting population research among faculty and students throughout Stanford, the SCPR is led by Professor Shripad Tuljapurkar, co-editor with Karen Eggleston of the book Aging Asia: Economic and Social Implications of Rapid Demographic Change in China, Japan, and South Korea.

The Stanford Center for Population Research, based in the Institute for Research in Social Sciences, has leadership and involvement across campus including the Humanities, Natural Sciences, Environmental programs, and the Medical School. The goal is to promote, support and develop population studies through collaboration among researchers and training for undergraduate and graduate students, serving as both a resource and nexus for faculty at Stanford across disciplines with interests in population studies, broadly defined.  

The Asia Health Policy Program will work with the Stanford Center for Population Research in studying the implications of demographic change in the Asia-Pacific region. For example, Karen Eggleston is undertaking comparative study of population health trends in China and India with other Stanford faculty associated with SCRP.

AHPP will also support the mission of strengthening the teaching of population studies at the undergraduate, graduate and postdoctoral levels, by helping to make connections for students studying demographic change in Asia. The 2011 postdoctoral fellow in Asia health policy, Qiulin Chen, will be studying population aging in China in comparative perspective. Shorenstein APARC’s affiliation with the SCRP will also help to reinforce the new Shorenstein APARC initiative studying policy responses to population aging in East Asia, kicking off with a workshop in January 2011.

Karen Eggleston, Director of the Asia Health Policy Program, seeks to hire two research assistants at the advanced undergraduate or graduate social science level to assist with several projects, including an international comparative study of government financing for health service provision and provider payment. The RA should have a solid background in microeconomics; some background in health economics and comparative health policy; and near-native fluency in English. Knowledge of another European or Asian language (especially Chinese, Japanese, or Korean) would be an advantage. Ideally the RA would be a student whose own studies are related to the topic of health care financing and payment incentives in developing and/or transitional economies, or more generally in public economics, the government sector, and social protection policies. The work would be for autumn quarter, with possibility of extension to winter quarter. Compensation is competitive and commensurate with RA experience. Please send CV and brief statement of interest and related qualifications to Karen Eggleston at karene@stanford.edu by September 24th.

On February 26, 2009, the Asia Health Policy Program and the Stanford Center on Longevity co-sponsored a conference entitled Aging Asia: Economic and Social Implications of Rapid Demographic Change in China, Japan, and Korea. Held at the Bechtel Conference Center at Stanford University, the conference brought together scholars from China, Japan, Korea, Singapore, and the US with expertise in demography, economics, biology, political science, medicine, health services research, social policy, and psychology.

Topics of discussion included how demography shapes individual, social and economic transitions in China, Japan and Korea; intergenerational transfers and the impact of population aging on economic growth; the challenges to financing health care, long term care, and pensions in China, Japan and Korea; the chronic disease burden and comparative international experience with chronic disease management; and perspectives from Singapore on public policy for aging populations. 

A book gathering together the policy-relevant insights of the conference presenters will be forthcoming in 2010, edited by Asia Health Policy Program Director Karen Egglestonand Professor of Biology Shripad Tuljapurkar.