Can the problem of not having children be solved by technology alone?

"Carry out assisted reproduction treatment with equal emphasis on traditional Chinese and Western medicine" and "relax the applicable groups of assisted reproduction"...

At this year's National People's Congress and National People's Congress, quite a number of NPC deputies and members were concerned about the issue of childbirth. In the past two years, the number of births has decreased, employment pressure has increased, and the effect after the introduction of the three-child policy has not been fully reflected, which has led to prominent fertility problems.

Seeing that the appeal has a limited role, the only problem that can be solved technically is "wanting to be born but not being born", so this year's discussion on fertility of the deputies and members mostly focused on the field of assisted reproduction.

According to incomplete statistics from the Health Bureau, at least 20 deputies and committee members submitted suggestions or proposals related to childbirth. Among them, Li Chuyuan, deputy to the National People's Congress and chairman of Guangzhou Pharmaceutical Group, An Ting, member of the National Committee of the Chinese People's Political Consultative Conference and chairman of Beijing Xiken International Culture and Art (Group) Company, all expressed the idea of developing assisted reproductive treatment in their suggestions or proposals.

In 2021, more than 10 provinces and cities including Shanghai, Tianjin, and Guizhou issued documents planning to increase the number of assisted reproductive service institutions, with little response; In early August 2022, Beijing issued new rules on medical insurance reimbursement of assisted reproductive technology, but soon announced a moratorium. An Ting mentioned that in 2018, the domestic assisted reproduction penetration rate was only 7%, while the United States was as high as 30.2%.

Many people put their expectations of having more children on medical insurance to reimburse the cost of assisted reproduction.

Price is the biggest dilemma

According to the results of a survey conducted by the Health Bureau on assisted reproductive treatment, under normal circumstances, the current cycle cost of the first and second generation IVF technology in China is between 30,000 yuan and 50,000 yuan, and the cycle cost of the third-generation technology with the highest success rate is even as high as 130,000 yuan to 200,000 yuan.

Although Beijing's previously planned assisted reproduction reimbursement program included 16 major items, the actual reimbursement rate was only 20%-30%, and patients often needed multiple cycles of treatment to succeed, and the average treatment fee generally reached more than 100,000 yuan. Moreover, the reimbursement scheme was aborted.

Allowing medical insurance to reimburse more is the most direct way to motivate fertility that deputies and members can think of. An Ting believes that for patients in need, reducing the cost of treatment may increase their enthusiasm for treatment.

The Health Bureau has noticed that in the past two years, there have been continuous calls for assisted reproduction to enter medical insurance. In 2022, Zhou Songbo, a deputy to the National People's Congress and president of Zhuozhou Fanyang Hospital in Hebei Province, suggested that "technically mature, safe and reliable assisted reproductive technology should be included in medical insurance"; The court proposed to fully integrate assisted reproductive medicine into social security.

In August last year and February this year, the National Health Commission, the Medical Insurance Bureau and other departments have repeatedly emphasized that assisted reproduction will be included in medical insurance "gradually". But no specific roadmap was given, and the first step of "step-by-step" did not know how to get out.

In the past few years, medical insurance has indeed made great efforts to control costs in order to retain the demand for anti-epidemic. For example, in the first half of 2022, the current balance of medical insurance in Beijing was 31.611 billion yuan, but Guizhou only 8.84 billion yuan.

If the whole country promotes medical insurance reimbursement for assisted reproduction, it is difficult to ensure the fairness of childbirth; If it is not promoted as a whole, it is difficult to ensure reproductive fairness.

An Ting suggested that the assessment ratio should be formulated considering the medical insurance balance in different regions, and the part of the medical insurance fund that is insufficient can be supported by the special funds of the state finance.

Huang Yuguang, a member of the National Committee of the Chinese People's Political Consultative Conference and head of the Department of Anesthesiology at Peking Union Medical College, also suggested that childbirth analgesic care should be popularized to the grassroots level and included in the national medical insurance catalogue to collect independent fees to reduce the burden on childbirths; Li Yan, a deputy to the National People's Congress and president of Qilu Pharmaceutical Group Co., Ltd., suggested that the cost of diagnosis and treatment of maternal depression should be included in the reimbursement scope of maternity insurance.

Appropriate relaxation of technical applicable standards

At the end of February this year, data released by the National Bureau of Statistics showed that by the end of 2022, the number of Chinese population decreased by 850,000 year-on-year, with a natural growth rate of -0.6%, the first decline in nearly 60 years.

At present, not only is it a problem of not having children, but also the phenomenon of young people not getting married. The economic and social environment puts too much pressure on this generation of post-90s and post-00s, which is reflected in childbirth, which becomes not getting married and not having children.

Xu Congjian, a member of the National Committee of the Chinese People's Political Consultative Conference and president of the Obstetrics and Gynecology Hospital Affiliated to Fudan University, suggested that women who are unmarried but have a strong desire to have children can be allowed to "preserve their fertility" first, and then carry out assisted reproductive treatment in accordance with the corresponding procedures after other fertility conditions are met.

"Freedom to freeze eggs" is respected by many single women, but the state thinks about another level of problems. Eggs are not organs, and buying and selling eggs is not a crime of buying and selling human organs, and in practice, it is generally cracked down on with other crimes, with limited strength. In August 2021, the National Health Commission made it clear that egg freezing for single women for the purpose of delaying childbirth does not comply with mainland laws and regulations, and may also lead to the commercialization of eggs.

Xu Congjian believes that under the current tendency to encourage fertility, "the provisions on fertility technology should be appropriately modified." However, he also said that "we cannot let go too much and completely" to prevent the creation of wrong directions in society.

There are also representatives who advocate trying Chinese medicine. Li Chuyuan suggested that relevant policies should be formulated to encourage the development of assisted reproductive treatment programs that pay equal attention to Chinese and Western medicine. Baiyunshan Zhongyi Pharmaceutical is studying the "Kidney Nourishing Fetal Pill Assisted Reproduction Project", hoping to verify the effect of ancient remedies in assisted reproduction. Kidney nourishing fetal pills sold 420 million yuan in 2021, making it the second best-selling variety in the company's internal medicine medication.

Even if these means are used, can children be born in large numbers? I'm afraid no one is sure. Most of the recommendations that can be implemented immediately only solve the problem of wanting to be born but not being born, and how to make people "want to live" requires a higher level of overall planning.

Written by|Gu Yue

Editor|Jiang Yun Jia Ting

Operations | He Anying

Illustration | Visual China

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