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    China Is Trying to Boost Fertility. Can Its Sperm Banks Keep Up?

    Although sometimes talked about as a solution to the country’s falling birth rate, the country’s assisted reproductive technology facilities, including sperm banks, aren’t ready for prime time.
    Apr 14, 2023#health

    Coverage of the COVID-19 pandemic often focuses on the damage done to industry, education, tourism, or public health. But we’re far from understanding the full fallout of the past three years. If you need proof, look no further than China’s recent sperm bank crisis.

    With college students — the most sought-after donors — largely confined to their campuses since 2020, sperm banks started the year with a critical shortage of sperm. Institutes around the country have put out calls for new donors, offering thousands of yuan in compensation to those who meet screening standards.

    Not that long ago, this might have been written off as a niche issue, but over the past eight years, China’s family planning policies have swung dramatically from strictly limiting births to actively encouraging larger families. The longstanding “one-child policy” was relaxed to accommodate two children in 2015, then again in 2021 to allow families to have up to three. Family planning officials estimated (or perhaps hoped) the new policies would increase the number of births per year to 20 million. Instead, the number plummeted to 9.56 million in 2022, its lowest level since the nation’s founding in 1949.

    In response, Chinese President Xi Jinping announced in September 2022 that the country “will establish a policy system to boost birth rates and pursue a proactive national strategy to respond to population aging.”

    Much as overpopulation was seen as damaging to economic development by the architects of the one-child policy, commentators and academics like Wang Feng, Yi Fuxian, and Yi Zeng argue the current relaxation is driven by concerns that underpopulation will exacerbate care burdens and cause economic problems as the country ages and the labor force shrinks.

    In short, provincial officials across China are looking for new ways to increase birth rates. Given that family planning policies have for so long been focused on limiting births through the provision of contraception, pregnancy termination services, and sterilization, this change in orientation and objectives poses a real challenge. Improving parental leave conditions for parents, providing cash “baby bonuses,” and, most recently, allowing single mothers to give birth without penalty are just some of the initiatives being proposed and implemented around the country.

    As an anthropologist who has spent years studying the development and routinization of assisted reproductive technologies (ART) in China, including sperm banking and in vitro fertilization (IVF), I have been particularly struck by how these technologies are now being talked about as part of the “solution” to the country’s falling fertility rates. There is talk of building more IVF clinics in order to improve access; in some cities and provinces, officials have even started subsidizing fertility treatments. (A single IVF cycle can cost almost $6,000, with many couples needing to undergo multiple cycles before conceiving).

    By 2019, there were 517 ART treatment centers and 27 human sperm banks nationwide. But sperm continues to be in short supply. There are numerous reasons for this, the most consequential of which — eye-catching reports about COVID-19 aside — are structural.

    First, the scale of potential demand is large. China is home to an estimated 1 to 2 million men with azoospermia, a medical condition that leaves them unable to produce their own sperm. At the same time, current health regulations allow for a maximum of five women to achieve a live birth with a single sperm donor, compared to between 12 and 30 in much of Europe. This means that Chinese sperm banks must constantly recruit new donors — often through campaigns on college campuses. Some sperm bank directors told me they live in a constant “state of emergency.”

    Second, the barriers to donation are quite high. Although commentators have suggested that taboos around masturbation and sex can make the work of sperm banks difficult in a country like China (think of the proverb “one drop of sperm is the same as ten drops of blood”), during my fieldwork I met many young men who had a relaxed, even humorous attitude regarding their decision to donate.

    Yet many of those who make their way to a sperm bank, spurred on by the promise of compensation as high as 7,000 yuan ($1,023), end up being disqualified. Only a minority of potential donors are able to produce a sperm sample of sufficient quality. The bar, at 60 million sperm cells per milliliter, is four times higher than the World Health Organization’s criteria for normal male fertility, a necessity to ensure the best possible pregnancy rates for couples. As a consequence, only around 20-25% of potential donors end up qualifying. Making matters even more difficult for sperm banks, there are concerns that sperm quality in China is declining due to pollution and lifestyle factors, with some of the country’s scientists raising fears of a reproductive crisis.

    Meanwhile, for all the talk of boosting birth rates, access to ART remains limited. Unlike countries such as Denmark or the United States, the use of sperm donors is limited to married couples in China. In January 2023, provincial officials in the southwestern province of Sichuan indicated that all citizens — including unmarried couples and single women — would be able to register new births without penalty, yet another initiative aimed at boosting fertility. It will be interesting to see whether this means that single women and unmarried couples will also be given access to ART treatments and sperm donors.

    Perhaps concern about falling birth rates in China will bring about a cultural change in attitudes towards single mothers and same-sex parenting. I would certainly encourage family planning officials in China to consider subsidizing, if not covering entirely, the costs of fertility treatment for people who need it. However, treating ART as a solution to falling fertility is a mistake. Access to ART should be expanded because people living with involuntary childlessness are suffering. It is not a substitute for broader reforms to make starting and growing a family easier.

    As with other urgently needed reforms, like ensuring that parental leave is properly compensated, gender discrimination on the labor market is eliminated, office cultures that require long working hours are changed, and child care and housing made more affordable, this will not be a quick fix. Improving China’s fertility rates will ultimately require a fundamental rethinking of how society works.

    Editors: Cai Yiwen and Kilian O’Donnell; portrait artist: Zhou Zhen.

    (Header image: Jan Tepass/Image Broker/VCG)