[Beijing = E-Daily Lee Myeongcheol Correspondent] China, which is grappling with a low birth rate, is implementing a “zero-cost” policy starting from the pregnancy stage. Under this system, the state provides support for everything from prenatal checkups to childbirth and even miscarriages. China began providing nationwide childcare subsidies for infants this year, and efforts to boost the birth rate continue.

According to China’s state-run Xinhua News Agency on the 9th, the Shanghai Municipal Medical Security Bureau announced the “Notice on Improving Policies Regarding Medical Cost Coverage for Childbirth in Shanghai” the previous day, stating that it will implement universal, cost-relief coverage measures for prenatal checkups, hospital deliveries, and childbirth in other regions starting October 1.

According to the notice, women giving birth who are enrolled in Shanghai’s employee medical insurance can use medical expense subsidies for all examination items, starting from the time they create their prenatal record during pregnancy through the 42-day postpartum checkup.

The subsidy limit is 4,500 yuan (approximately 900,000 won) per person; after this limit is exhausted, maternity insurance will cover the remaining costs in full. Maternity insurance is a social insurance system through which the state provides living and medical expense support to employed women in China during their maternity leave.

According to the Shanghai Municipal Medical Security Bureau, the basic medical care service package under maternity insurance has been improved based on the existing basic medical care service items under the urban maternity insurance program. It includes the general medical examinations required for women from the time they establish their prenatal care records through the 42-day postpartum recovery checkup.

Chen Danfei, Deputy Director of the Social Security Division at the Shanghai Municipal Medical Security Administration, explained, “Previously, women enrolled in Shanghai’s employee medical insurance—including maternity insurance—had to pay out-of-pocket first and then apply for a 4,500 yuan maternity medical expense subsidy after giving birth. Now, they can present their social security card or electronic medical insurance credentials to pay for prenatal checkups at designated hospitals.”

The eligibility for maternity insurance has also been expanded. In addition to those enrolled in Shanghai’s occupational health insurance, women giving birth who are enrolled in urban or rural resident health insurance can now also receive the benefits of this service package.

Furthermore, maternity insurance will fully cover all in-policy hospitalization costs incurred by insured women from the seventh month of pregnancy through 42 days postpartum, from the time they are admitted to the obstetrics and gynecology department of a Shanghai-designated medical institution until their discharge from the obstetrics ward. The same insurance coverage standards as for childbirth also apply in the event of a miscarriage after the seventh month of pregnancy.

The expansion of insurance benefits for women giving birth in Shanghai, a Tier 1 city in China, is part of a series of childbirth support policies recently implemented.

According to China’s National Bureau of Statistics, the number of births in mainland China last year was 7.92 million, a 17% decrease from the previous year (9.54 million). The number of births in China has remained below 10 million for four consecutive years, with the last time it exceeded 10 million being in 2021 (10.62 million).

China has not disclosed its total fertility rate (the average number of children a woman of childbearing age is expected to have in her lifetime) since 2022, when it fell to 1.07. However, the Singapore United Daily News, citing experts, estimated China’s total fertility rate last year to be between 0.97 and 0.98. This is significantly below the replacement fertility rate (2.1) needed to maintain the current population size, indicating that China, too, is facing the onset of a “population cliff.”

China is implementing various measures to boost its fertility rate. Since last year, it has been providing a nationwide childcare subsidy of 300 yuan (approximately 60,000 won) per month for infants aged 0 to 3. Maternity allowances are also provided to women who have paid maternity insurance premiums.

Local governments are also introducing their own programs. A village in Changping Town, Dongguan City, Guangdong Province, has implemented a reward policy that provides 5,000 yuan (about 1 million won) for the birth of a first child and 30,000 yuan (about 6 million won) for a third child. Mingxi County in Fujian Province provides 2,000 yuan (approximately 400,000 won) for the birth of a first child, 3,000 yuan (approximately 600,000 won) for a second, and 5,000 yuan for a third, along with 4,000 yuan (approximately 800,000 won) in childcare support per semester. Families with two or more children receive a subsidy of up to 150,000 yuan (approximately 30 million won) when purchasing a home.

Policies to encourage marriage are also in place. In Lüliang City, Shanxi Province, first-time married couples under the age of 35 receive a cash payment of 1,500 yuan (approximately 300,000 won), while in Shunde District, Foshan City, Guangdong Province, the amount is 2,500 yuan (approximately 500,000 won). In Baiyun District, Guangzhou, Guangdong Province, first-time married couples receive up to 80,000 yuan (approximately 16 million won).

Hao Zha, an associate professor at the School of Law at China Women’s University and a director of the China Marriage and Family Research Association, analyzed, “The fact that the state is using incentive tools, such as financial payments, to encourage and support marriage and childbirth demonstrates that modern public governance is shifting from a focus on regulation to one centered on support.” She added, “The costs of marriage, which were primarily borne by families and individuals, are gradually shifting toward being shared by the state, local governments, and society.”