The Individuals in the Numbers: Reproductive Autonomy in the Shadow of Population Planning in China and India

It was never quite her decision. ‘I wasn’t ready to be a mother, but it was impossible not to,’ Hui (a pseudonym) said during our interview in 2016, not long after China’s decades-long One-Child Policy ended. Her husband had made it clear to her that the ‘DINK’ (Double Income, No Kids) life—which Hui had long idealised and believed would ease the pressure of living in Beijing—was unacceptable to both him and his parents. From the moment Hui turned 25, well-meaning family members never hesitated to point out that her ‘most fertile years’ were quickly drying up. Eventually, Hui relented, giving birth to a baby girl at 28, a year after her marriage. ‘It’s fulfilling an obligation,’ she quietly noted.

Sitting among a small group of women in an infertility clinic in Lucknow, India, Amrita (a pseudonym), a Sikh woman, explained to us: ‘Whatever happens, the one who has nobody—’ She trailed off and then started again: ‘To become a mother is the most important job. Outsiders say: “That poor lady.” The one who doesn’t have any children learns what their importance is.’ The other women around her nodded in agreement. They understood the criticism women endured for being childless, not only from family members, but also from more distant relatives, neighbours, and even strangers.

Stories such as these remind us that childbearing stands at the intersection of the biological and the social, the personal and the political (Almeling 2015; Ginsburg and Rapp 1991). How individuals make decisions about parenthood—and the meanings they attach to children—reflects a society’s deeply rooted norms about gender and family. This is what we tend to forget when we discuss demographic trends in the world’s two most populated countries: China and India.

In January 2023, China reported its first population decline in more than six decades: a shrinkage of 850,000 people. The last time the country saw a drop in its population was 1961, three years into the famine ensuing from the Great Leap Forward. The United Nations estimates that in April 2023, India has traded places with China to become the world’s most populous country (United Nations 2023). Each home to more than 1.4 billion people, China and India have long conjured images of crowdedness. Discussions of the two countries’ populations are often preoccupied with the issue of size, with alarms going off for both growth and decline. But what are the stakes in asking whether they have too many or too few people?

Population Governance in Contemporary China

In China, population planning has been a crucial part of the Party-State’s political calculations for decades now (Greenhalgh 2008; Wang et al. 2013). Despite a sharp decline in China’s total fertility rate (TFR) throughout the 1970s, in 1980, the Chinese Communist Party (CCP) instituted the One-Child Policy in the hope of producing a population size most optimal for jumpstarting economic development and fuelling the country’s rise in the global order (Greenhalgh 2008; Whyte et al. 2015). China’s TFR has stayed below the replacement level since the early 1990s (Cai 2008; World Bank 2023). In recent years, as the Party-State grew increasingly concerned about the adverse implications of China’s rapid population ageing and diminishing demographic dividend, population governance has taken a sharp pro-natalist turn.

The One-Child Policy that has left indelible marks on China’s family structure and population sex ratio is gone. In 2016, the Party-State sanctioned a second child for all married heterosexual couples in mainland China, and the quota was increased to three children in 2021. Local governments have since been rolling out a variety of measures to incentivise births—from extending maternity leave and promising cash benefits to vowing to provide easier childcare access. In this vein, in May 2023, the China Family Planning Association (CFPA), a ‘people’s organisation’ under the CCP’s leadership tasked with promoting family planning, announced a 20-city pilot program aimed at promoting ‘new-era marriage and childbearing cultures’ to create a ‘childbearing-friendly society’ (see CFPA 2023).

Reproductive Autonomy in the Shadow of the Patriarchy

From the beginning of the One-Child Policy to its nationwide relaxation since 2016, population governance in China is rooted in a quantitative vision: counting humans and engineering a population size that will best achieve the Party-State’s political and economic objectives. On one hand, extensive scholarly and journalistic writing has documented the gendered abuse and infringements of people’s right to have children under the draconian One-Child Policy (for a review of the literature, see Whyte et al. 2015). On the other, the relaxations of birth quotas and the myriad new incentives for births have ushered in an alliance between a newly pro-natalist state and entrenched patriarchal familial demands. Just like Hui, many women are viscerally aware of such expectations from their families of timely marriage and childbearing. Biting back their hesitancy and mixed feelings, they sometimes view having one child as the ‘natural next step’ after marriage—an obligatory act that will ‘complete’ the marriage and transform the couple into a ‘real’ family (Zhou 2019).

But what is a ‘real’ family, and who can or cannot be a part of it? How does the imaginary of an ‘ideal’ Chinese family end up marginalising some people? Whereas for some Chinese women, like Hui, motherhood has become an obligation that is nearly impossible to avoid, for others—especially those existing outside the institution of heterosexual marriage—it is a right that has long remained elusive. Heterosexual marriage continues to be regarded as the necessary precondition for childbearing and the foundation of a family in China. Unmarried women encounter persistent challenges in accessing assisted reproductive technology, like egg freezing, and maternity benefits. Even among highly educated young urban Chinese women today, non-marriage unions, such as cohabitation, continue to be viewed with apprehension—as carrying distinct gendered risks and stigma (Zhou 2022a).

At the same time, for all the clamour surrounding China’s population decline, LGBTQ+ people—and their desire for family and rights in parenthood—have been rendered largely invisible. Recent years have witnessed unrelenting crackdowns on LGBTQ+ activism, spaces, and lives in China (see also Wang’s op-ed in the current issue). Marriage and family are synonymous with heterosexuality. In this sense, while the Chinese Party-State is incentivising births, only one kind of sex is allowed. National data from throughout the 2010s show that about 80 per cent of the Chinese public believes that same-sex sexual behaviour is always or mostly wrong (Zhou 2022b).

India’s Ambivalent Reproductive Governance

In India today, reproductive policies enable fertility choices. Policy has taken different guises since the 1950s, when India first instituted family planning programs aimed at reducing the birthrate; today, a wide range of contraceptives are widely available on the market. Some forms of contraception can also be obtained for free or at a reduced cost in government health facilities. Abortion has been legal since 1971 and it is readily provided, with little debate about the issue except for sex-selective abortion, which has been a common practice among people seeking sons. Diagnosing foetal sex has been illegal since 1994, although the law has been difficult to enforce and there have been repeated modifications to further discourage the practice (Ram 2001; Singh 2018; Sreenivas 2021).

Since 2005, government programs have been encouraging hospital deliveries—for instance, by providing cash subventions, which has led to dramatic increases in people giving birth in hospitals rather than at home, particularly in rural areas, where nearly 70 per cent of India’s people live (Unnithan 2019). Infertility treatments, including assisted reproductive technologies such as in vitro fertilisation (IVF) and other specialised procedures, are available, even though clinics offering these tend to be clustered in larger urban areas and in private facilities, creating financial and other barriers for the less well-to-do.

There are no national policies regulating births, but some states have enacted limits on access to elected office or social support programs based on the number of children, barring people with more than two children from running for office or receiving welfare, such as subsidised food. Other states have proposed such policies, but ultimately abandoned them after public protest. Policies shape what services are available, where, and how much they cost, but cultural and familial perceptions of appropriate reproduction are at least as important as policy in the everyday dimensions of reproduction, and very often what others will think or say weighs heavily on individual decisions.

The idea of ‘population’ still resonates powerfully with many people in India and elsewhere in the world. India has long been labelled a crowded country, with many often wrongly attributing its scarcity of food and water, ecological damage, and economic deprivation to the large numbers of people who call the country home. India’s total land area is much smaller than China’s, so, in comparison, there are more people sharing less space. Stories that focus on the country’s high population, as well as those that address ethically troublesome practices—such as India’s rise as a destination for foreigners seeking children through transnational gestational surrogacy services that were once provided by Indian clinics (Deomampo 2016; Majumdar 2018; Pande 2014)—may divert attention from other reproductive experiences. For example, India is also home to millions of people who experience infertility problems, such as Amrita and her companions at the infertility clinic discussed above. Since India banned transnational surrogacy and the increase in awareness of assisted reproductive technologies, more domestic stories about the inequalities and inequities of surrogacy and other experiences with infertility are beginning to be heard (Majumdar 2022; Pande 2021; Singh 2014).

Reproductive Decisions between Control and Autonomy

A focus on numbers overshadows the personal and familial dynamics that influence fertility, including the timing of marriage, birth, and spacing between births, as well as underlying desires to create a new social role for oneself such as that of ‘mother’, or to fulfil other expectations of one’s own or family members, such as the longing for sons. Although it is difficult to track infertility in India numerically because of the attached stigma and lack of data from large-scale studies, estimates have suggested that more than 18 million couples are affected by this in the country (Ganguly and Unisa 2010). The (un)availability of infertility treatment, financial challenges, intrafamilial dynamics, as well as social perceptions shape the decisions of people like Amrita and can limit their options.

In our interviews, Indian women seeking infertility treatment talked about wanting children not only for themselves, but also for their extended families. In cases of secondary infertility, women talked about wanting to give their existing child a sibling. Some researchers argue that the spectre of infertility looms large over decisions about the timing of marriage and reproduction because of the stigma associated with remaining childless, especially for women (Unnithan 2019). Many Indians I have met in the more than 15 years since I started field research learned about the advanced biomedical infertility services available mainly through private clinics because of movie stars’ stories of IVF and surrogacy or through media accounts of foreign individuals and couples seeking infertility treatment in India because of prohibitively high costs or restrictive laws in their home countries.

Even though many Indians have embraced the idea of smaller families, living as a single person, living married life without children, or using non-normative family-making strategies such as adoption, these remain transgressive (Bhargava 2005; Lamb 2022). Experiences of infertility and involuntary childlessness have all too often been left out of stories of lower-income, higher-fertility countries and accounts that ignore the perspectives of people marginalised because of their class, caste, religion, race, or ethnicity, rendering these categories what researchers have called the ‘invisible infertile’ (Fledderjohann and Barnes 2018).

While providing universal infertility treatment has been identified as a global need for nearly three decades, few countries have reached that goal. In India, the infertility of people marginalised due to their religious, caste, or class identities remains largely invisible and, for many people, unimaginable (Singh 2020). Studying fertility and infertility ideologies and experiences through the lens of popular culture and everyday life shows the nuances of reproductive life in India beyond statistical reports (Singh 2017). Policy that takes all reproductive experiences seriously can contribute to increasing reproductive autonomy, even when women consider the desires of other family members while making decisions about their own bodies.

Finding the Individual in the Numbers

In short, conversations that overwhelmingly focus on problematising population size miss the mark, glossing over questions about reproductive autonomy—or the lack thereof. As individuals are being flattened and reduced to numbers, largely swept into the shadows are people’s—especially women’s—everyday struggles and negotiations for the right to both have and not have children. In China, left uninterrogated are the heteronormative assumptions baked into population governance about what an ‘ideal’ family should look like or how ‘good Chinese women’ should behave. In India, continued emphasis on reducing fertility hinders the full realisation of fertility desires, even when these are about having small families, especially among members of groups marginalised because of socio-religious status or fertility struggles, within or beyond heteropatriarchal norms.

In its 2023 State of World Population report, the United Nations Population Fund recommends that people and policymakers ask whether and to what extent women can make their own decisions about reproduction (UNFPA 2023: 4). Forty-four per cent of women around the world cannot decide autonomously about their own health care, sex, or contraception. Nearly half of pregnancies are unintended. Treatment options for infertility remain out of reach for much of the world’s population.

According to the population projections from the United Nations (2023), India’s population matched and then surpassed the population of mainland China in April 2023. As the title of the ‘world’s most populous country’ changes hands, it is critical to not miss the individuals in the numbers—that is, to assure people of their rights to work towards the families they wish for and the tools to help them along the way, offering a path to brighter possibilities for the future, in India, China, and elsewhere.



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Holly Donahue Singh

Holly Donahue Singh is an anthropologist and Associate Professor of Instruction at the Judy Genshaft Honors College at the University of South Florida in Tampa. She is the author of Infertility in a Crowded Country: Hiding Reproduction in India (Indiana University Press, 2022).

Yun Zhou

Yun Zhou is an Assistant Professor of Sociology at the University of Michigan. Intersecting the studies of population and politics, her current project investigates the demographic, political, and gendered consequences of China’s reproductive governance.

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