Last week, Xu Zaozao, also known as Teresa Xu, received the final verdict for a lawsuit she filed in 2019 against an obstetrics hospital that denied her access to egg-freezing services. Rejecting Xu’s third appeal on Aug. 7, the Third Intermediate People’s Court in Beijing sided with the hospital, saying it did not violate her rights by doing so. For the claimant, the outcome of a six-year battle for reproductive rights came as no surprise. “I was mentally prepared for it,” she said in a live stream on her social media account. “This result wasn’t all that unexpected.”
The 36-year-old women’s rights activist and writer first approached the hospital to freeze her eggs in 2018 after she broke up with her then-boyfriend, spurred by the realization that despite being unmarried and not wanting to put her career on hold, she wanted to have children someday. Instead, doctors urged Xu to marry and get pregnant sooner rather than later, as Chinese law allows only married couples to undergo the procedure of egg freezing. She decided to challenge the limits of fertility treatments in China in the first legal case of its kind. “It feels like my right to choose is always controlled by others,” she told reporters at the time.
In the early 2000s, the country’s National Health Commission issued rules that would allow single men to freeze their sperm. Yet, the law excludes single women from exercising the same rights. Though the court has now handed a decision that goes firmly against Xu’s wishes, the case has sparked a heated debate over gender equality in the country, with rights activists arguing that an overwhelming patriarchal culture in China excludes single women from exercising choice in their reproductive journey.
“From a societal perspective, single women do not conform to traditional family values,” says Li Maizi, a renowned Chinese activist and campaigner for gender equality. “But as the first person in China to dare to challenge this unreasonable policy, Xu Zaozao has successfully brought the issue of egg freezing and assisted reproduction for single women into the public eye, making it an unavoidable social issue.”
Declining birthrates spur population crisis
The court’s decision comes at a time when China faces an urgent population crisis caused by aging and historically low fertility rates. Last year, the country’s population shrank—a first since 1961—as the fertility rate fell under 1.2 per woman, below the rate of 2.1 needed to keep a population stable, according to UN data. Concurrently, the number of Chinese households with just one person increased from 8.3% in 2000 to 25.4% in 2020. And while traditional, nuclear families remain the norm, more young women have begun delaying getting married and having children, including those in relationships. The number of registered marriages in China during the first half of this year dropped to the lowest level in a decade.
These trends are widespread in other East Asian countries, too: the combined populations of China, Japan, South Korea, and Taiwan will shrink by 28% between 2020 and 2075, according to the U.N.
Read More: Why Women in Asia Are Having Fewer Babies
In China, the ruling Communist Party has had a say over family planning for years, though officials have gradually loosened rules around the one-child policy by allowing families to have two children by 2016, and then three by 2021. To respond to the population crisis, President Xi Jinping pledged “a national policy system to boost birth rates” in 2022. Beijing has since offered incentives to encourage married couples to have more children that range from cash handouts, tax cuts, and property concessions, to making in vitro fertilization and other reproductive services more widely affordable.
These measures reflect how marriage is established as a gateway to children in China, says Melanie Meng Xue, a professor at the London School of Economics and Political Science. “Aside from viewing children as the property of the husband’s family, rather than something women might desire from themselves, the Chinese Communist Party has reinforced this perspective by implementing policies that make marriage a prerequisite for obtaining a permit to give birth,” says Xue. She adds that without this permit, parents cannot officially register their child.
In light of these restrictions, single mother communities have united to fight for their rights for years by asking for “maternity allowances” and “maternity insurance”—compensation given to mothers for missed work income while pregnant. In 2021 Zhāng Méng, a single mother from Shanghai, successfully secured maternity insurance after battling the courts for four years.
Officials nevertheless justify the ban on single women from freezing their eggs by pointing to the health risks involved with women giving birth at an older age. Experts have pushed back by pointing out that the procedure—which requires hormone injections and an egg retrieval procedure that takes place under anesthesia—is the same for single and married women. Moreover, a 2015 peer-reviewed article by Sun Xiaoxi, the deputy director of the Genetics & IVF Institute at Fudan University’s Obstetrics & Gynecology Hospital, stated the risks associated with egg freezing were “small probability events.”
Read More: Can China’s Baby Bust Be Reversed? Don’t Count On It
Single women turn to other options
Given the restrictions, single Chinese women have instead turned elsewhere to seek the expensive procedure. In 2015, Chinese film star Xu Jinglei caused a stir when she revealed that she had undertaken an egg-freezing procedure in the U.S. two years earlier. Travel companies have also begun catering to these needs, with websites like Ctrip.com offering a seven-day tour of California that includes sessions at a clinic for egg freezing.
Li says that while the U.S. remains a popular destination to undergo the procedure, women have also sought services in Southeast Asian countries like Thailand and underground IVF clinics in China. “The enormous reproductive demand from non-mainstream groups has stimulated the market, giving rise to many gray industries,” she says.
But for the majority of Chinese women wishing to access these services abroad, the high cost remains prohibitive. “I would’ve done it already if I could afford it,” one Guangzhou government office worker in her early 30s told CNN.
It will take a while before Chinese society can widely accept the use of IVF technology to allow women more reproductive options, Xue at LSE says, but Teresa Xu’s case has nevertheless highlighted the growing awareness among younger Chinese women of their reproductive rights, or lack thereof, as well as their desire to have children at a time of their choosing.
“The current legal and social frameworks need to evolve in ways that are meaningful for women’s autonomy and rights,” she continues, “but even in a society that is not traditionally rights-based, it is not impossible to see policy changes occur.”
Even Xu, the claimant, noted the positive language in the court judgment despite the verdict during her live stream: “As our country’s policy on births is adjusted, relevant medical and health laws, regulations, diagnosis and treatment standards, and medical ethics standards may also change accordingly.”