An unmarried woman fights for her right to freeze her eggs in China

Last year, a Beijing court ruled that a hospital did not violate a woman’s rights by refusing to freeze her eggs because she was unmarried. Now, her ongoing appeal has reignited debates over women’s reproductive autonomy in China — regardless of marital status.

Teresa Xu, an unmarried 35-year-old Chinese woman, began her final appeal in a Beijing court on Tuesday, in a landmark case of female reproductive rights in the country.

In 2019, Xu, a freelance writer who is using the pseudonym Xú Zǎozǎo 徐枣枣, sued Beijing Obstetrics and Gynaecology Hospital for refusing to freeze her eggs because she was single. But she lost the case last year when Chaoyang Intermediate People’s Court in Beijing ruled against her, saying that the hospital did not violate her rights.

“The final verdict — one way or another — may serve as a powerful symbol. Depending on the verdict, it would either further entrench deeply heteronormative familial and gender norms, or open up a glimmer of possibility that might expand existing notions of who can have children and what Chinese families could look like,” Yun Zhou, an assistant professor of sociology and Chinese studies at the University of Michigan, told The China Project.

Population problems

China has been fighting to boost its lowest-ever birth rate, with 6.77 births per 1,000 people as of last year. China’s total population shrank by 850,000 to 1.41 billion in 2022, while India overtook China as the world’s most populous country by the end of last month, according to the United Nations.

The downward trend has pushed Chinese officials to roll out new measures to boost its birth rate. After scrapping the one-child policy in 2016, the government since introduced several policies to encourage young couples to have more children. As of 2021, families can have up to three children. The central and local governments have also doled out a raft of support measures, such as tax relief and housing credits, educational benefits, and even cash handouts for burgeoning families.

The province of Sichuan earlier this year even removed marriage as a prerequisite for having children, a move that would have been unthinkable in China a decade ago. But single mothers are still widely discriminated against by various parts of the Chinese state, including its healthcare system.

“If Ms. Xu wins her case and if the Chinese government relaxes the rules on who can have access to reproductive technologies nationwide, that’s a good thing. But the government’s motivation is to boost [the] birth rate, not because it now believes every woman should have equal access to reproductive technologies,” Yaqiu Wang, a senior China researcher at Human Rights Watch, told The China Project. “In other words, it’s out of necessity, rather than genuine improvement on women’s rights, and the Chinese government still views women as a tool for reproduction.”

Family help is reserved only for traditional married women

Unlike couples, single women in China still struggle to access assisted reproductive technology (ART), such as egg freezing.

China passed a law in 2001 that granted access to ART only to infertile married couples, who are entitled to have children under China’s family-planning laws. The laws prohibit single or unmarried women. A 2003 regulation allowed men to save their sperm through sperm banks regardless of their marital status. But the rule did not extend the right to single women who want to freeze their eggs.

The Chinese government has long held the position that only married couples should be allowed to exercise their reproductive rights. Women who want to freeze their eggs must be able to present a marriage certificate, state-issued birth registration form, ID card, and proof of infertility.

“The reason the Chinese government bans egg freezing for unmarried women stems from its patriarchal view on how Chinese society should be structured,” Wang told The China Project.

Greater access to fertility or reproductive treatments, such as egg freezing and in vitro fertilization (IVF), could boost the birth rate by enabling older women or those struggling with infertility to have children. In February, China’s National Healthcare Security Administration announced that the country’s insurance fund will begin to cover ART, which can cost several thousand yuan, to ease the financial burden of infertility treatment on families. Labor analgesia such as epidurals, which offer pain relief during childbirth, would also be covered by insurance. But these policy sweeteners are available only to married couples, even though a growing number of women in China are choosing to stay single.

Will China expand women’s access to ART?

Some signs from local provinces and the greater public have emerged that reflect the ongoing debate to allow all women — married or not — greater access to ART.

While government policies want only married couples to bear children, marriage rates are on the decline: About 44% of women do not intend to marry, according to a 2021 survey conducted by China’s Communist Youth League. From 2013 to 2020, the number of couples who married in China dropped 39.5% from 13.469 million to 8.143 million, according to the China Fertility Report in 2022. Meanwhile, couples are delaying having children: The average age of first-time parents rose from 24.1 in 1990 to 27.5 in 2020.

Currently, the northeastern province of Jilin is the only place in China that allows single women above the legal age of marriage to freeze their eggs. In Sichuan, the local health commission announced in January that starting on February 15, there will no longer be a limit on the number of childbirths a person can register, nor will there be any more restrictions on who can register new births, following similar moves adopted or deliberated in the provinces of Guangdong, Shaanxi, and Anhui.

In February, Lú Wěiyīng 卢伟英, who works as a fertility doctor in China’s southern Hainan Province and is a member of the Chinese People’s Political Consultative Conference (CPPCC), which offers advice to the government on various policies, suggested a proposal to grant unmarried women access to egg freezing, as a measure to boost fertility rates. Other CPPCC delegates have also suggested similar changes. While reports indicated that China’s National Health Commission (NHC) is considering liberalizing the egg-freezing policy for single women, those efforts seem unlikely to gain traction.

The women who are not included

The government’s conditions of approval — and the perks that come along with it — exclude a vast number of women who reside outside China’s traditional family structures.

Government help to alleviate the cost of ART is restricted to married couples. Single women, who are not members of a double-income household, are more likely to be unable to afford such procedures. In Shanghai, the average cost of a fertility treatment session is between 30,000 and 35,000 yuan ($4,500 to $5,000). That does not include the added costs of anesthetics and other drugs, surgery, or choice of a sperm donor. And even if a woman does decide to shell out those funds, the treatment may not work the first time around: The success rate of IVF for women under 35 is about 50%. That rate drops to 20% for those over 40. Repeating the process makes it all the more unaffordable, and as of now, with the existing rules in place, the only other option is to go abroad.

Meanwhile, a growing number of women are choosing to delay bearing a child, or choosing to not have one at all, due to financial pressures or career development. There are also women seeking to get pregnant who do not identify as heterosexual, and are therefore unable or unwilling to meet the marriage conditions of ART, since China does not recognize same-sex marriage.

“Familial and gender norms in contemporary China have remained deeply heteronormative, despite the demographic and socioeconomic transformations over the past decades: Childbearing is still largely viewed as something that ‘should’ happen within the context of heterosexual marriages,” Zhou told The China Project. “Despite relaxations of birth quotas, at the heart of China’s population and family policies are still heteronormative notions of what an ‘ideal family’ should look like and who can be a part of such families.”

Opponents of single women’s access to ART, whether it be the state or society, have often cited traditional family values, or the supposed negative social implications of a rise in single-parent families. Some talk about the potential health risks of infection, due to the invasive medical procedure of IVF or egg freezing. Others have also argued that it helps to prevent the commercialization of egg selling and surrogacy, an illegal and — to some — taboo practice in China.

Even outside China, the topic remains controversial. “International studies have shown that the technology’s success rate drops as a woman’s age increases,” the commission cited. “In the U.S. and Europe, experts have also clearly said that commercialized egg-freezing technology gives false hope to women, who may then postpone childbearing to a later age.”

While there is some legitimacy to their concerns, legally, the ban on the ability for single women to freeze their eggs has not proven to be necessary to safeguard their interests. Some lawyers claim that such restrictive legal measures rest on the assumption “that women cannot make rational decisions for their health even with adequate informed consent procedures, that banning egg freezing by single women promotes a culture of having children ‘at a proper age,’ and that egg freezing by single women offends China’s public moralities have not been substantiated.”

Those in favor of liberalizing ART also argue that those restrictions undermine a woman’s choice over her own body. Many in the country have criticized the ban as discriminatory and sexist, considering there are no such barriers for single men seeking to freeze their sperm. They argue that the rules deprive women of their bodily autonomy, and their right to have children however and whenever they so choose.

“In addition to difficulties in accessing reproductive technologies and maternity benefits, unmarried women — straight or queer — are often also excluded from the imaginary of ‘good’ mothers: That is, women’s decision to have children outside of the structure of heterosexual marriage is frequently stigmatized as irresponsible, selfish, ‘not normal,’ and/or ‘bad for the kids,’” Zhou said.