Putting China’s rising infertility rate in the proper context requires doing the homework

The last couple of weeks have seen many news outlets covering China’s rising rate of infertility, citing that estimates put the rate of infertility in 1983 at 3% and a recent study has shown today’s rate to be as high as 10% in many regions. The rate increase has variously been attributed to abortions, lifestyle choices, the One Child Policy, and a rising trend towards women giving birth later. The tone of secondary coverage has been panicky, and critical, in equal measure, as if China’s infertility rate is somehow unique. The opening phrase

“China appears to be suffering from rising infertility levels

is particularly ominous and sets the tone for the rest of the piece. Let’s look at how this story has been distorted, and how it can be corrected by means of a better opening sentence.

It’s important to keep all studies of China grounded within the proper context of 1.3 billion people. Out of context, Chinese statistics will always seem larger than life. One blogger said, “many may be surprised to learn that the home to the world’s largest population also has more infertile couples than several countries combined.” That is true, but one should also point out that these theoretical ‘many people’ would laugh at their own surprise when reminded that China has a lot more people than several countries combined. This means that when looking at universal phenomenons like food consumption, number of hours slept, or infertility, China is always going to have more than another individual country, and depending on which countries you choose, more than several countries combined.

Keeping things within the proper context for China, means using statistics that deal with percentages and ratios. For example, in the case of infertility, the number of interest when talking about China’s infertility rate in relation to the world’s is 10%. The fact of the matter is that China’s infertility rate of 10% (meaning it effects 10% of couples) is right where one would expect it to be. The global infertility average is 10%. And, according to a 2002 WHO report, “It is commonly accepted that infertility affects more than 80 million people worldwide. In general, one in ten couples experiences primary or secondary infertility, but infertility rates vary amongst countries from less than 5% to more than 30%.”

The rate of infertility in China, therefore, is not uniquely terrible. If the claimed rise in infertility tells us anything it’s that China is now more like the rest of the world: whether or not this is a global issue is another question altogether (it’s definitely something we shouldn’t ignore).

Notice that I use the word “claimed” when referring to the 1983 infertility rate. The statistics from 1983 are all estimates based on very scant, unstandardized data. According to Emily McDonald Evens, MPH, of the University of North Carolina’s Department of Public Health,  infertility is a stigmatized condition and perennially underreported. Moreover, the definition of infertility varies across culture, and changes as culture changes. Evens wrote the most comprehensive shorty study of global infertility trends that I could find. On the subject cultural variation in definitions of infertility she says:

It is important to remember that the definition of infertility varies between cultures and that the Western, clinical definition cited above may not capture variation in cultural perceptions on childlessness. Infertility often does not strictly mean the inability to give birth to a child; in some places the inability to have the number of children that cultural norms dictate maybe considered involuntary childlessness; in other places infertility may be understood as having no sons, or not becoming pregnant soon after initiating sexual activity. (2, 8) Social norms concerning marriage, divorce, and family organization influence perceptions of childlessness to a large degree.

Consider that, in China, a couple’s ability to have children is intimately linked with social status, and that still today, China’s hospital and MoH records are spotty, there is little reason to take serious any estimates about the rate of infertility in China in 1983. Notice also that I put in bold how in some societies the concept infertility is extended to couples who don’t have sons. If , in China, infertility was thought of as an inability to have sons, wouldn’t families want to hide that fact? The rate of infertility in China could have very well dropped since 1983, or it could be pretty much the same.

Now the story about China’s infertility rate is much more grounded than before. The opening sentence of an interesting news story, at this point, could read “China’s rate of infertility has reached the estimated world average, but it is hard to tell whether the rate is higher or lower than before. What lessons does the rest of the world have to offer?”

But, before we have a final story its important to look at one more thing. None of the news stories do a good job distinguishing between primary infertility and secondary infertility. Evens, again, defines the two kinds of infertility like this;

Primary infertility is defined as childlessness and secondary infertility as the inability to have an additional live birth for a parous woman.

Contributing to the panicky tone of news stories on China’s infertility is that all cases of infertility are treated like cases of Primary infertility. As if there is some great pandemic of social irresponsibility, smoking, drinking, and abortion that is making couples not able to have children at all. The opposite is, in fact, true. Couples are still having children, but, increasingly, many couples prospects for children are limited by prior abortions, and careers that force them to have children later. What the journalists actually wanted to describe, but couldn’t due to poor research, is that cases of secondary infertility appear to be rising as a result of life style changes.

So here is our second draft of what the opening sentence should have been: “Lifestyle changes in China could be contributing to the rise of secondary infertility rates. They might be further evidence of China’s development”. The title is informative and still has a dramatic hook, though this time, the hook speaks more honestly about China and gives more informative food for thought. It’s not simply that China’s growing infertility rate is worrying, it’s that the secondary infertility rate seems to be connected to development, and this is worrying for everybody the world over.

Finally, what does the One Child Policy have to do with this? Well, probably something, but definitely not everything. The first thing to realize is that the infertility rate is not the opposite of fertility rate. When one goes up the other doesn’t go proportionately down. They are related, but are not mirror images of one another. The One Child Policy has certainly changed China’s fertility rate, evidenced by China now ranking in the bottom 15% of all countries for fertility rate whereas sixty years ago it added 400 million people to its population. This drop in fertility does not mean that it has cause the infertility rate to go up. One can posit that increase abortions because of the One Child Policy led to a higher Secondary infertility rate, but to my knowledge there have been no studies that have definitively linked the two.

So now, we have our final draft of an opening sentence: “Chinese lifestyle changes could be causing a rise in secondary infertility rates. As the country’s rate comes further in line with that of the developed world, might we be seeing intriguing further evidence of the country’s development? Or is it simply a product of The One Child Policy? Our reporters say that the cause and effect mechanisms are not simple, but are illuminating. “

Comments

  1. says

    Yeah, lifestyle changes really affect the infertility rate. This is a global issue. People have to learn more ideas about getting pregnant to reduce the infertility rate instead of suffering pain of infertility.

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