"Our best affiliated hospital here, in the past, it was difficult to build a file, and at the peak, it was necessary to open a special window, and only put 8 numbers a day, which was more difficult than grabbing high-speed rail and plane tickets during the Spring Festival." Now they are all let go, and we must actively promote patients to go to them."
Wang Luo, chief physician of the obstetrics department of a third-class hospital in Guangzhou, said, "The number of pregnant women in the country is declining, and everyone is trying their best to win over patients."
At the same time, voting data released by Lilac Garden Weibo showed that nearly 70% of users said that "the number of obstetric inpatients in their hospitals decreased compared with the same period last year".
Source: Lilac Garden Weibo
Clinicians' feelings are consistent with the trend of fertility data released by the mainland.
In 2016, the two-child policy was opened, and the new population reached a peak that year, and the new population in the mainland has shown a downward trend in the following 5 years. According to data released by the National Bureau of Statistics, the net increase in the national population in 2021 will be 480,000, and the annual birth population will be 10.62 million, which is the lowest year since the founding of New China.
Note: The net population growth data of the mainland from 2015 to 2021 shows a clear trend of first rising and then falling
The overall situation has decreased year by year, and the epidemic has highlighted the downward trend
Such a change is not surprising to Liu Yan, deputy chief physician of the Obstetrics Department of Tianjin First Central Hospital, "Judging from the number of files established by Tianjin Maternal and Child Center, not only has it decreased significantly in some months, but the overall situation has decreased in recent years, and the epidemic has highlighted this."
In December 2020, the mainland launched a large-scale COVID-19 vaccination campaign. From March 2021, the number of new vaccinations on the mainland will almost exceed 3 million per day.
"Although the National Health Commission mentioned that vaccines do not affect pregnant women, from our clinical perspective, newborns are no different. But some parents may think that their child's health needs a longer period of observation, so they are more inclined to wait for a while before trying to conceive."
According to the pregnancy cycle, "the decline in the number of people at the end of 2021, we actually know from the beginning of the year." During the time when all the staff were vaccinated in March and April last year, the common idea was to suspend and postpone the birth plan, and this part of the population was generally born in December."
Yang Jinrui, deputy director of the Department of Population and Family of the National Health Commission, mentioned in an interview with the People's Daily that he believes that the decline in the birth population in recent years is caused by multiple factors. "The decline in the size of women of childbearing age, especially women of childbearing age during the period of fertility boom, is the main factor driving the decline in the number of births."
During the "13th Five-Year Plan" period, the average annual decrease in women (aged 20 to 34) during the fertility boom period in the mainland was 3.4 million, and in 2021 it was 4.73 million less than the previous year. At present, there are about 330 million women of childbearing age (15-49 years old) in China, which is expected to drop to 200 million to 240 million by 2050.
While the number of births has decreased, the willingness to have children has continued to decline. Chen Li, attending physician of the Obstetrics Department of Shanghai Pudong Hospital, told Lilac Garden, "In the overall environment, the willingness of the younger generation to have children is low, especially in big cities. Our hospitals have counted local and foreign production data this year, and local only accounts for 1/3 of them." According to the National Bureau of Statistics, the average number of intended children for women of childbearing age on the mainland dropped from 1.76 in 2017 to 1.64.
In contrast to the decline in fertility among women of childbearing age, there is a marked increase in the number of elderly women admitted by hospitals.
Chen Hanyu, an obstetrician from a third-class hospital in a first-tier city in the north, revealed that this year the department received a pregnant woman in her sixties. In the county hospital at the border port, it is more common for women who have four or five children.
In the border county town of Guangxi with a population of 280,000, an obstetric nurse in a grass-roots hospital told Ding Xiangyuan: "The proportion of elderly pregnant women in the hospital is high, and there are still many third and fourth children. The highest number of births in the county should be 3300 in 13 years, 2674 in 2020, and the downward trend in 7 years is very slow."
The increase in the number of elderly and multiple-child mothers has also increased the corresponding risk of pregnancy, and strengthening the education of patients has become a concern for clinicians. Dr Lau Yan said that in clinical work, it is often found that many women "have no fertility conditions at all, neither assess their physical condition nor undergo regular pregnancy tests".
"For example, we recently admitted a five-child mother who gave birth to one in 2015, 2017, 2019, 2020 and 2021. This fetus was too experienced to give birth, and it took me 33 weeks to come to me. In the end, the child had a cleft abdomen, and the entire liver and intestines were all outside."
Grassroots hospitals have the greatest impact, and maternal and child health care hospitals as a whole are stable
From the perspective of geographical distribution, first-tier cities with developed economies and large inflows of population such as Guangzhou and Shanghai can attract patients from other provinces in addition to local residents, and the decline in the number of hospitalizations is relatively small.
According to the 2021 statistical yearbook data, the net inflow of population in the four first-tier cities in beijing, Shanghai, Guangzhou, and Shenzhen ranked in the top four. Among them, Shenzhen and Shanghai have a net inflow of more than 10 million, and Guangzhou ranks third, with a net inflow of 8.89 million. Correspondingly, local doctors in Guangzhou said that the hospital fell between 10% and 20%, and the overall decline in Pudong District hospital was between 6% and 30%.
Source: CBN
From the perspective of hospital level, the grass-roots hospitals with the amount of childbirth as the main means of revenue are the most affected; the head hospitals with high grades and strong comprehensive strength fluctuate relatively little; and the maternal and child health hospitals with high resource integration and service level and good reputation are relatively stable.
For hospitals that do not take the volume of delivery as the main indicator and receive chronic high-risk pregnant women for a long time, the length of patient hospitalization period is long, and the decrease in the number of patients is not obvious.
Taking Shenzhen as an example, Yu Xin, an obstetrician at the local top three hospitals, said, "The best time is in 2017, the monthly delivery volume is close to 1,000, the maximum month can get a bonus of 18,000+, and the number of surgery days is 18." Since last year, the delivery rate in our hospital has seen negative growth, and now it is very good to have 10 surgeries a day. At present, there are two or three hospitals that maintain positive growth in the number of births, and all of them are maternal and child health hospitals with stable reputations."
The overall number of births is reduced, high-level hospitals are more inclined to actively strive, patient referral is strengthened, and grass-roots hospitals are more likely to lose patients due to insufficient technology and service levels.
For example, Liaoning Chaoyang Hospital, in recent years, the number of people has not dropped but risen, ju Wei, the hospital's obstetrician attending physician, said: "In recent years, there has been a steady upward trend, and the population of our city is relatively fixed, so it is possible that the number of hospitals at the county and district levels has been relatively reduced."
Zhang Liran, an obstetrician at a grassroots hospital in Tianjin, gave an example, "We have a patient with a history of spinal cord injury, and it is actually no problem to have a caesarean section in our hospital. But as soon as her family said that they wanted to go to the city, the city immediately issued him a hospitalization certificate and made an appointment for hospitalization, and we were all very surprised. Before, our patients were transferred to the city, and often 10 patients would come back to 4, but this year there was no such situation."
Public data show that in 2016, when the comprehensive two-child policy was opened, the number of local midwifery institutions in Tianjin was 92, and the number of statistics under the impact of the current epidemic was 60. "Some grass-roots hospitals with weak technical level have even directly abolished obstetrics, leaving only gynecological departments." Zhang Liran said.
However, for large hospitals with good comprehensive strength and strong treatment capacity, from the perspective of hospital operation pressure and safety factor, the reduction in the number of hospitalizations is not entirely a bad thing.
Liu Yan shared a set of data that in 2016, the number of monthly newborns in Liu Yan's hospital nearly doubled, "almost from 300 to 600, doubling the workload." We have 66 beds, but usually 100 beds are added. At the most exaggerated time, we would lead the patient up to see her and tell her that if you could put your foot down, we would let you live in."
At present, with the current reduction in the number of patients admitted, the phenomenon of "even spinning up and down the operating table, the patient did not see the doctor after giving birth", "extra bed in the elevator door and case discussion classroom", and "critically ill pregnant women running all over the city can not find the hospital" have been alleviated.
In addition to focusing on fertility rates, doctors have mentioned abortion rates. Chen Li, attending physician of the obstetrics department of Shanghai Pudong Hospital, suggested that figuring out the reasons behind the abortion data may help solve the problem of birth rate: "The number of abortions in the country from 2018 to 2019 was as high as 9.74 million and 9.76 million, respectively, which is about to catch up with the number of newborns in the country in a year." (Curator: Beatrice, Leu.)
Note: In the article, Wang Luo, Chen Hanyu, Yu Xin, and Zhang Liran are pseudonyms.
Executive Producer: Gyouza
Title image source: Visual China
Author: Mangosteen