Medical Examiner

After the One-Child Policy

China changed its single child restriction in 2016, but the country still has a lot of work to do toward making motherhood work for women.

A mother and child hold hands while walking through a vast landscape knitted by two massive hands.
Doris Liou

In June, CCTV—China’s state-run television channel—aired a story online about a young mother who picked up a hobby during a prolonged period of postpartum depression that morphed into something bigger. The report detailed how Mao Wan, a 30-year-old mother of two, started knitting after she gave birth to her first child in her husband’s hometown. The craft became a bulwark against her inner despair that lasted until her son was a year old.

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When Mao later moved back to Shanghai after having her second child, she kept knitting as a side gig to mothering. She knit so much that she made an art project out of it, covering the entire length of the railing in a public shopping center in a “sweater” of green, red, yellow, and purple with little knitted rabbits hanging off the corners.

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The internet embraced Mao’s knitted success story as one of motherly fortitude triumphing over desperate circumstances, all bravely laid bare for public display. It was, in the way of popular internet videos, heartwarming: She knit her depression away. Offline, though, her story offers a more complex narrative, one that is relevant to the current set of questions about how Chinese women are weathering motherhood.

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The experience is complicated by the country’s legacy of fertility control, which, for decades, dictated decision-making around reproduction. China’s one-child policy, the countrywide regulation introduced in 1979, is regarded as an unfounded experiment in fertility regulations with treacherous consequences. By government estimates, the policy prevented as many as 400 million births, though that number is disputed by researchers who say it is based on inflated projections and that China’s birthrate would have declined on its own without state intervention.

Still, the one-child policy skewed the country’s average age wildly upward and created a gender imbalance. Women who gave birth under the one-child policy had few choices but to follow fertility guidelines. Those who had more than one child had to pay child rearing fees; others underwent forced abortions and sterilizations.

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Just over four years ago—in October 2015, one month after Mao gave birth to her son—the Chinese government announced that it would implement its new two-child policy, which would go into effect at the beginning of the following year.

It was received as a positive step for reproductive rights in China, following more than three decades of strict fertility controls. But the change in policy and the experiences of the women who have had children afterward help illustrate how much the fertility restrictions’ legacy still influences the experience of becoming a mother in China. It’s a process that is largely dictated by tradition and filial piety, often at the expense of personal choice and women’s health.

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With the implementation of the two-child policy, women have gained more fertility freedom than the generation that came before. But even so, one of the enduring legacies of China’s birthing policies is that the country’s women are, in many ways, struggling when it comes to addressing the worries of motherhood.

Stories like Mao’s are a telling chapter in China’s new fertility story, one in which women are starting to express how powerless they continue to feel when it comes to giving birth, despite (slightly) more fertility freedom, and starting to openly talk about other concerns around child rearing that previously weren’t discussed much, if at all.

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This is playing out most prevalently on the internet, where the anxieties of motherhood are tumbling out, compared with the real world where they are still, on the whole, constrained.

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Mao is soft-spoken and remains unruffled when her daughter gets fussy during our interview at a glossy mall in her Shanghai suburb. When she tells the story of her elder son’s birth, she describes it as traditional to the core. At her mother-in-law Zhao Aiying’s request, Mao gave birth at a small local hospital where Zhao knew the gynecologist. Mao says her room in the hospital was bare-boned; she’d used a table to block the door after she realized she couldn’t lock it.

She’d planned to give birth naturally but had a C-section because doctors said she didn’t have enough amniotic fluid to deliver safely. Two weeks after the baby was born, her husband, Pei Chao, had to go back to work in Shanghai. Mao remained with his parents, in Heze, a lower-tier city in Shandong province, where Mao was going to spend the next year and a half after giving birth.

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The postpartum period in Chinese culture is considered an important time for both the mother and baby. The concept most closely translates to “sitting month” and lasts anywhere from 30 days to around two months after a woman gives birth. Depending on where she delivers the baby, there’s a set of guidelines about what the mother should eat and wear, and how much physical activity she should do during this time.

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Mao’s mother-in-law is from a rural area in Shandong, where women stick closely to traditional sitting month guidelines, which meant Mao was going to spend her postpartum time the way her mother-in-law did it, and the way her mother-in-law’s mother did it before her.

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Mao had met her in-laws a few times during her visits to her husband’s hometown but hadn’t spent more than a few days at a time with them. When she moved in, communication didn’t flow naturally. After giving birth, she had a milk blockage that made breastfeeding painful; it’s from this sticky mixture of biological and situational discomforts that Mao said her anxieties bloomed. “So many things were crowded into my heart,” she said. “I didn’t want to express them at the time.”

The weather in September when she moved in with her parents-in-law still retained some of its summer flair, with breezes warmer than the air itself. She didn’t use the fan in her room. She didn’t bathe or wash her hair that month, as tradition would have it. Mao kept with custom because she felt like it was what she was supposed to do. She bundled the baby in layers, she ate what she was served, and she didn’t leave the house, except on rare occasions.

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Mao’s anxieties were compounding in a way that she never knew they could. She agonized silently when her father-in-law would feed the baby when she didn’t think he was hungry. She worried that, because her baby wouldn’t roll over right away, he might have cerebral palsy. She fretted that, with a weakened bladder after birth, she’d sneeze and pee her pants in public. She feared that when it happened, everyone around her would laugh at her.

Conversation between Mao and her parents-in-law was limited by cautious cordiality. Phone calls with her husband, Pei, were cursory due to time and distance. For the most part, Mao didn’t bring up her feelings. “I didn’t want to cause too much conflict. I also had a kind of attitude that I respected them and endured it,” she said.

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She was miserable. So, she knit. She knit, and she knit, and she knit. The hobby she’d first picked up in college became a compulsion. Her parents-in-law found it enigmatic, much like Mao found her mood at the time. But in creating each piece, she found logic. When she focused on weaving threads one by one, the rest came together naturally.

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“At the time, my brain was like a machine running on high speed: Did I make a mistake in this loop? How do I fix it? The whole time was me knitting and ripping, knitting and ripping,” she told me during our interview in July. Her knitting acted as a salve, but her symptoms persisted. “I really don’t think there was anything happy in life that could make me laugh, ” she said about her mood at the time.

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Around three months after giving birth, Mao decided to post on a WeChat mothers’ group, describing her symptoms: sleeplessness, body pain, and anxiety. Other women in the group responded: It sounded like postpartum depression. The words felt sour to her. “I was scared, very scared,” she said. “I had been exposed to this word [depression] before, but I never thought that this word will appear on me. … I felt I cannot accept this reality at the time.”

He Yanling said she’s seen how societal norms feed into maternal stress during almost two decades working as a Shanghai-based psychiatrist and consultant for maternity hospitals in other parts of the country. “Anxious” is a common message she hears from mothers who talk to her about their child birthing experience, often stemming from family pressures or worries about how childbirth might affect their work. “Because of the baby, they might lose their job, so they worry about this,” He said.

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Complaints from new mothers against employers for pregnancy discrimination are common in China, despite there being laws against it. Even under the two-child policy, there are examples of companies that try to fire women for having more than one child and cut their pay or terminate them if they become pregnant.

He said the severity of anxious and depressive symptoms among new mothers depends on a mix of biological and situational factors, including the degree to which women feel able to express their symptoms, and what’s contributing to them, to their family, friends, and wider social circles. She thinks prenatal anxiety, which she said is widespread, could signal a higher risk for postpartum depression and should be used as a screening tool: “It’s not just postpartum. That’s late. We should work before that.”

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Efforts to address the dearth in support that women are feeling with regard to childbearing are largely piecemeal, said Wang Ziwen, a doctor who is working to implement a comprehensive screening program for postpartum depression in her district on the outskirts of Shanghai.* “The psychological part has not been popularized in the country. It is still quite early,” she said.

At one of the maternity hospitals in Heze, the city where Mao gave birth, a gynecologist was quick to tell me that one of the neighboring hospitals had a program that works with new mothers who have mental health problems—but she wouldn’t talk about postpartum depression on the record herself, because she saw it as too sensitive.

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An overarching idea that mental health challenges of any kind should be kept private contributes to a general reluctance among women to ask for help. While she’s seen more women seeking counseling in the past few years, He said she still finds women have a hard time verbalizing the root of their problems and pinpointing how they emotionally manifest, partly, she says, because depression remains a touchy subject.

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Most of the time, mothers have to actively seek out psychological support; He said they often don’t. She puts mothers from her counseling sessions into WeChat groups where they can talk with one another about their symptoms. Because many of the mothers she consults come from outside of Shanghai, and then spend a month after birth in confinement, they are otherwise isolated, like Mao was.

Mao described the extent of her social seclusion as being in a self-constructed cage. Even after seeking advice from other mothers about postpartum depression on social media, she didn’t consider going to counseling, partly because it would have meant admitting what she was feeling to her husband, her parents-in-law, and herself. “There was a very shameful feeling when it happened to me,” she said.

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Instead, she tried to keep herself busy with activities—like her knitting—and said she only started feeling like herself again around her son’s first birthday. Her CCTV interview was one of the first times Mao talked openly (offline) about her postpartum experience and how it affected her. It was also the first time her husband and parents-in-law learned just how serious her situation was during that time.

In a group on QQ, a Chinese social media application similar to the one from which Mao sought advice, more than 400 women describe their struggles after birth, which include symptoms of anxiety and depression, mixed with descriptions of the social conditions to which the women attribute the problems’ roots. At times, conversations turn to trivial motherly gossip, recommendations for household products, and complaints about oblivious husbands.

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But interwoven are messages about the obligations of motherhood and fears about employment and child rearing. In one conversation I was following last fall, when new moms expressed symptoms of postpartum depression, the conversation turned to seeking psychological help—which some of the women believed was a waste of time. “The doctor will only say that I can cure myself,” one QQ user wrote.

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Occasionally, there are direct mentions of China’s fertility policies, as mothers describe their qualms about having another baby given their experiences with their firsts. For a generation of mostly only children, the bandwidth required to raise multiple children is also a uniquely stressful phenomenon. There are also online forums specifically for questions from two-child mothers: How do you split time and attention between two kids, and how do you afford the same level of care paid to one?

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The persistent lack of maternal support these women are describing is one indicator that the two-child policy change is only one step in reorienting a system that, for a long time, was not focused on women’s health, said Lü Pin, an activist who first started covering women’s issues as a reporter, and later as founder of Feminist Voices—an online platform that was banned from social media by the Chinese government last year.

When the two-child policy first went into effect, Lü was among the critics. “Young women know that they cannot have more children, or they should not have more children if there is not enough protection for their equal rights,” she told me. She didn’t see the changes to the policies as altering the strong traditional value placed on successful child rearing. Yes, it would allow women who wanted to have more children to do so, but the way it was enforced still represented what was ultimately a lack of choice, she thought.

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“It seems so long as policy allows for it, giving birth doesn’t require a reason but not giving birth does require a reason,” she wrote in an essay in 2013, after the selective loosening of the one-child policy (from 2013–15, couples who were each only children themselves could have another child).

Despite the shift toward more liberal fertility policies, in recent years there has also been a resurgence of messages about filial piety pushed by the state, most prominently President Xi Jinping’s “New Era” doctrine, announced in early 2018. Along with abolishing presidential term limits, the plan details a vision for China’s progress in which women play traditional roles as mothers and wives.

Last year, for example, the state-run All-China Women’s Federation helped found the New Era Women’s School, a class designed to teach young women skills like how to sit properly and behave well in social settings. At the same time, the New Era doctrine encourages women to actively participate in the workplace.

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Women outnumber men in Chinese universities, and according to the World Bank, 61 percent of all women 15 and older work. But despite statistics that would suggest women are advancing in society, Lü said China’s official doctrine, which publicly voices support for equality, is vexed in practice without complementary policies for maternal support that eradicate rather than strengthen gendered expectations.

These conflicting pressures create a social script around childbearing that yields, among other things, emotional precarity. But women are finally starting to talk about these competing interests—at least, among themselves.

Yuan Jie, a 38-year-old mother of two, was taking her son to English class when she first saw Mao’s knitting project on display in Shanghai. She later signed up for a parent-child knitting class Mao organized and felt a kinship with the fellow new mom. It was only after the news report about Mao came out that Yuan learned they’d experienced some of the same melancholic postpartum symptoms.

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At an Ikea in the eastern edge of the city with her sons in tow, Yuan describes how her own postpartum experience carried her through months of anxiety and fear, which she only attached a name to months after and now talks about with a particular gusto, as one does with topics that have for so long gone unmentioned.

After four prior miscarriages, Yuan’s first baby was born prematurely—just bigger than a kitten, he weighed just over 3 pounds. After 63 days, she was finally able to take her son home from the hospital, but she was afraid that he would never grow. She felt embarrassed when she saw other healthy babies developing normally.

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She couldn’t explain to her husband, who was busy with work, or her parents-in-law, whom she was living with at the time. During her sitting month, her stresses compiled. “I was very depressed. I was worried about my baby, and I had to do all of the housework, so I was worried about that too,” she said.

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Yuan had trouble breastfeeding and said her mother-in-law criticized her for not being able to produce enough milk to properly feed her son. And he was so small. When she watched him sleep, Yuan would touch his nose to make sure he was still breathing. There were times when she felt both she and her baby would be better off dead.

“Sometimes my thoughts would become so extreme that it made me want to just jump from the balcony with my child so that he could stop suffering, and I could stop suffering. It happened a lot,” she said.

Yuan said she didn’t talk about her feelings with many people because, when she did, they’d tell her she had too much time on her hands. “They feel that you have nothing to do and that you are idle,” she said. “No one will think that you are sick.” She sought advice from mothering websites and WeChat groups but, on the whole, still felt deeply alone.

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Even at her lowest points, Yuan remained grounded in practicality. She credits a sense of obligation to take care of her aging mother with keeping her going: “At the time, I really thought jumping out of the window with my child would solve everything, but I also thought about how my mom is getting old. What would happen to her if I died?”

The same force that grounded Yuan during her darkest times, though, remains a sticking point in China’s push to encourage fertility. An oft-cited reason why women in China are not having more children is that they understand that the social infrastructure, including child care and elderly support, is not yet in place for them to do so. Up until recently, there were few options for aged care in the country, a task that usually falls to children.

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Yang Juhua, professor of social demography at Renmin University in Beijing, said changing cultures around childbirth are slow in China, even with the two-policy adjustment. Along with more traditional practices like the sitting month, the expectation that women will bear the brunt of the responsibility of child rearing has stayed constant even as fertility regulations have loosened.

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Familial and gendered institutions in China remain more traditional than other developed countries in Asia—China still has a lower median marriage age, for example. Women who give birth out of wedlock face fines in some provinces and may face barriers utilizing public health care services. Unmarried women do not have access to reproductive technologies like in vitro fertilization and egg freezing. Women often cannot get a C-section in hospitals without permission from their family.

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Rather than pushing China to adopt more progressive views, though, Yang worries, the two-child policy may espouse greater inequalities. “[Women] still suffer from many traditional pressures,” she said.

There are incremental moves by the government to improve the conditions for women in the delivery room. Last fall, the government launched a pilot program offering “pain-free births”—epidurals—in select hospitals, which are currently given to around 10 percent of women who have natural births. The issue received attention after a 26-year-old pregnant woman jumped to her death after being denied a C-section, prompting an outpouring of anger from women on the Chinese internet.

Months later, the China Family Planning Association announced a plan to provide early childhood development programs and maternal health checks online.

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But efforts to make motherhood more enticing may not produce the intended fertility boom without corresponding social changes, which women have started to push for on their terms, too.

When she got pregnant with her second child earlier this year, Mao was adamant she didn’t want to have the same birthing experience as with her first baby. Instead, like others in her cohort, she opted for a new-age center for her sitting month, the kind that came with balloons after birth and postpartum activities like poetry readings. When she talks about it, Mao shows a video on her phone of a group of postpartum nurses gathered around her bedside in a brightly lit room.

She said she didn’t experience postpartum depression symptoms the second time around, which she attributes partly to knowing what to expect this time before it happened. She also doesn’t explicitly blame her depressive symptoms the first time on the conditions of her sitting month, or the divergent parenting styles of her in-laws.

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But she does say that the pressures she felt to keep with custom and act like a good daughter-in-law pushed her to keep her feelings to herself. Alongside messages of support in the comment section of Mao’s CCTV feature, there are also sentiments suggesting mothers should find their own cures for emotional woes, as Mao tried to do.

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Her parents-in-law were upset at first when they heard she didn’t want to spend her second postpartum months in their home. “It’s not proper,” her father-in-law Pei Zhongpin said when I visited Mao’s parents-in-law in Heze. But they also freely admit they were unaware of what Mao was going through, and if they had known, they would have had no idea how to talk about it.

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After Mao’s interview came out, Zhao said she was proud of her daughter-in-law, and shared the knitting video with friends, but didn’t usually bring up the part about Mao’s depression. At the time Mao was living with her, Zhao had an inkling that her sudden mood change might be something more serious. But she’d only heard about postpartum depression in extreme forms and didn’t want to mention it out of fear those extremes could manifest.

Yuan also had a better birthing experience the second time around—she already had one healthy son, Kangbao, meaning “healthy baby,” which she thinks helped her through it. Her second son is appropriately named Shunshun, which roughly translates to “everything goes smoothly and well.”

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Mao and Yuan don’t see each other much now that they’re not in the knitting group together anymore. Plus, they each have two kids to take care of, which keeps them mostly on their respective sides of town. Neither of them has gone back to work after having their babies, but they both have other things that keep them busy; Mao has started a page online to sell her knitted designs. Yuan volunteers at the Chinese Red Cross during her free time.

They’re happy to have each other to empathize with, though. They send each other WeChat messages, and they stay in touch through social media—which, for now, is a big part of the safety net for moms. They’ve learned that heavy feelings can be blunted if shared and that they’re allowed to talk, if only to each other, about how they want motherhood in China to look. “Most mothers are taking this matter on by themselves,” Mao said. “I hope that our society can pay more attention.”

This work was supported by a grant from the International Women’s Media Foundation. Additional reporting by Jaime Chu. 

Correction, Dec. 2, 2019: Due to an editing error, this piece originally misidentified Wang Ziwen as Maog Ziwen.

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