MLast week, Xu Zaozao, also known as Teresa Xu, received the final ruling in a lawsuit she filed in 2019 against a maternity hospital that denied her access to egg freezing services. The Third Intermediate People’s Court in Beijing rejected Xu’s third appeal on August 7, siding with the hospital on the grounds that it had not violated her rights. For the plaintiff, the outcome of a six-year battle for reproductive rights came as no surprise. “I was mentally prepared for this,” she said in a live stream on her social media account. “This result was not too unexpected.”
The 36-year-old women’s rights activist and writer first approached the hospital in 2018 to freeze her eggs after splitting up with her then-boyfriend. She had realised that despite being unmarried and not wanting to put her career on hold, she wanted to have children one day. Instead, doctors urged Xu to get married and get pregnant sooner rather than later, as Chinese law only allows egg freezing for married couples. She decided to challenge restrictions on fertility treatments in China, in the first legal battle of its kind. “It feels like my right to decide is always controlled by others,” she told reporters at the time.
In the early 2000s, the country’s National Health Commission issued regulations allowing single men to freeze their sperm. However, the law denies single women the same rights. Although the court has now made a decision that clearly goes against Xu’s wishes, the case has sparked a heated debate about gender equality in the country. Human rights activists argue that China’s predominantly patriarchal culture denies single women the opportunity to make their own decisions about their reproductive process.
“From a social perspective, single women do not conform to traditional family values,” says Li Maizi, a well-known Chinese activist and campaigner for gender equality. “But as the first person in China to dare to challenge this unreasonable policy, Xu Zaozao has successfully brought the issue of egg freezing and artificial insemination for single women to the public and made it an unavoidable social issue.”
DFalling birth rate leads to population crisis
The court’s decision comes at a time when China is facing an acute population crisis due to an aging population and historically low birth rates. Last year, the country’s population shrank for the first time since 1961 as the birth rate fell below 1.2 per woman, according to UN data, falling below the rate of 2.1 needed to maintain population stability. At the same time, the number of Chinese single-person households rose from 8.3% in 2000 to 25.4% in 2020. And while traditional nuclear families remain the norm, more and more young women have begun postponing marriage and having children, even if they are in relationships. The number of registered marriages in China fell to its lowest level in a decade in the first half of this year.
These trends are also widespread in other East Asian countries: According to the UN, the total population of China, Japan, South Korea and Taiwan will shrink by 28 percent between 2020 and 2075.
Read more: Why women in Asia have fewer children
In China, the ruling Communist Party has had a say in family planning for years, although authorities have gradually relaxed rules on the one-child policy. Families have been allowed to have two children since 2016 and three by 2021. In response to the population crisis, President Xi Jinping promised “a national policy to increase the birth rate” for 2022. Since then, Beijing has offered incentives to encourage married couples to have more children, ranging from cash gifts, tax breaks and property benefits to making in vitro fertilization and other reproductive services affordable.
These measures reflect the establishment of marriage as a gateway to children in China, says Melanie Meng Xue, a professor at the London School of Economics and Political Science. “The Chinese Communist Party views children not only as the property of the man’s family, but also as something women might want for themselves. It has reinforced this perspective by introducing policies that make marriage a prerequisite for obtaining a birth permit,” says Xue. She adds that without this permit, parents cannot officially register their child.
Faced with these restrictions, single mothers have been fighting together for their rights for years, demanding “maternity allowance” and “maternity insurance” – compensation for lost labor income during pregnancy. In 2021, Zhāng Méng, a single mother from Shanghai, successfully secured maternity insurance after a four-year legal battle.
Authorities still justify the ban on single women freezing their eggs by citing the health risks associated with giving birth at an older age. Experts push back, pointing out that the procedure – which requires hormone injections and egg retrieval under anesthesia – is the same for single and married women. Moreover, a 2015 peer-reviewed article by Sun Xiaoxi, deputy director of the Institute of Genetics and IVF at Fudan University’s Obstetrics and Gynecology Hospital, said the risks associated with egg freezing are “low probability.”
Read more: Can China’s baby bust be reversible? Don’t count on it
Single women are looking for other options
Faced with restrictions, single Chinese women have instead looked elsewhere to undergo the expensive procedure. In 2015, Chinese movie star Xu Jinglei caused a stir when she revealed that she had undergone egg freezing in the US two years earlier. Travel companies have begun to cater to these needs as well, with websites such as Ctrip.com offering a seven-day tour of California that includes sessions at an egg freezing clinic.
According to Li, while the United States remains a popular destination for the procedure, women are also seeking services in Southeast Asian countries such as Thailand and illegal IVF clinics in China. “The huge demand for reproductive devices from non-traditional groups has boosted the market and given rise to many gray industries,” she says.
But for the majority of Chinese women who want to use these services abroad, the high costs remain prohibitive. “I would have done it already if I could afford it,” a government employee in her early 30s told CNN.
It will be some time before Chinese society will generally accept the use of IVF techniques that give women more reproductive options, says Xue of the LSE. Nevertheless, Teresa Xu’s case has highlighted the growing awareness among younger Chinese women of their reproductive rights, or lack thereof, and their desire to have children at a time of their choosing.
“The current legal and societal frameworks need to evolve in ways that make sense for women’s autonomy and rights,” she continues, “but even in a society that is not traditionally rights-based, political change is not impossible.”
Despite the verdict, even plaintiff Xu noted the positive wording in the court ruling during her live stream: “As our country’s birth policy is adjusted, the relevant medical and health laws, regulations, diagnostic and treatment standards, and medical ethics standards may also change accordingly.”
