Not a married heterosexual woman? You might not get certain reproductive care in China

BEIJING — The first thing Teresa Xu noticed at a maternity hospital in China's capital was how many couples and relatives were there.

"It was a sea of people, mostly women, accompanied by their worried husbands and parents," Xu says.

Like many of the women, Xu was there to freeze her ovarian eggs. But unlike the others, she was unmarried and went alone — which didn't go over well.

"The doctor dismissively asked me, 'Why not get a marriage license first?' " Xu recalls. It was in November 2018, when she was 30 years old.

The public hospital refused to have her eggs frozen, citing its rule allowing only married women to do so.

Xu is suing the Beijing Obstetrics and Gynecology Hospital at Capital Medical University, arguing that no national law says a woman must be married to have the procedure. She filed suit in October 2019 and has gone to court hearings, but is still awaiting a decision.

This is one of the more publicized examples of Chinese citizens challenging a system they say deprives them of public reproductive care and benefits because they're unmarried heterosexual women or LGBTQ people. Experts note that these restrictions persist even as China's leaders are now encouraging families to have more babies.

"It comes down to conservative values, and unmarried women who have children are usually found to have violated the catchall legal rule of, quote, 'keeping up public order and morality,' " says Liu Minghui, a lawyer who testified in support of Xu in court last year.

China wants more children now

Last August, the government revised its laws to allow couples to have up to three children to boost the country's declining birthrate. That marked a big change.

For four decades, China had a strict rule limiting most families to just one child. In addition to tormenting the population with brutal enforcement, the country wound up with a shrinking workforce and growing numbers of senior citizens.

China raised the cap to two kids per family in 2016, but that did not revive the slowing population growth.

The strict birth limits also led to a patchwork of different rules around the country that shut out nontraditional parents from social benefits and reproductive services.

National public health care covers basic prenatal tests and delivery costs, but middle-class families often turn to private hospitals with higher out-of-pocket costs for more timely service. Different localities mandate nontraditional families pay all costs out of pocket, and may not guarantee new parents enjoy the same, lengthy maternity leave benefits traditional families enjoy.

"There are rules that say reproductive assistance services are only available to married couples, and while they don't mention egg freezing specifically, it's considered such a service," says Liu, who is a legal expert who specializes in gender discrimination cases. She points out unmarried men can freeze their sperm in China.

One woman found an alternate route to in vitro fertilization

To get around the restrictions, some unmarried people have taken matters into their own hands to have children.

One of them is Fen, a 33-year-old lesbian who cannot get married because China does not recognize same-sex marriage.

So she bought sperm from an American donor and now has twin toddlers. Fen says mothers like her have to use a more expensive private hospital in China for in vitro fertilization.

"Public hospitals won't take a case like mine. Even the sperm has to come from a private donor through an unregistered sperm bank," Fen says.

NPR is not using Fen's full name because having a child this way lies in a legal gray area. And recently, China has been quietly cracking down on LGBTQ reproductive services.

When it came time to register her childbirths, Fen left the father's name blank.

"I'm in total panic when people ask me who the father of my children is. Sometimes, I don't know how to respond," Fen says.

Fen often tells older friends who may have a harder time accepting her reproductive choice that her children's father is in the United States.

It's gotten easier to sign a child up to social security

China has made some improvements for unmarried mothers. It used to be nearly impossible to register their children for the Chinese equivalent of a social security number. But now just one parent can apply for this identification document, which is key to accessing education and social benefits.

"Now, the process is similar for all mothers. The only difference is unmarried mothers have to pay the cost of birth. Married mothers have it covered by state insurance," says an unmarried mother who lives with her toddler in the southeastern city of Shenzhen. She does not want to use her name because she fears the social stigma for having a child outside of marriage.

She says she was able to easily get her child a birth certificate, but with caveats. "The local office notified me that because my child was born outside of the national birth planning rules, my child cannot go abroad before they turn 18. If my child wants to become a public servant, they need to track down the father's information, too," the mother says.

More women could find themselves in a similar situation if they want children. Overall divorce rates have also soared — so much so that the government implemented a new rule last year requiring couples to wait 30 days before finalizing divorce proceedings, causing divorces to drop 70% within the first few months of the rule taking effect.

And a whopping 44% of urban women ages 18 to 26 in China do not want to get married at all, according to a survey by the Chinese Communist Youth League released in October. A quarter of men in that segment say the same.

In other words, family planning officials continuing to bank on only married couples having more kids may keep struggling to bring the birthrate back up. [Copyright 2022 NPR]