| An "obstretrics winter" has descended on China's hospitals, amid a wave of closures of delivery wards across the country. At least three public hospitals in several provinces have announced since the start of the year that they'll stop providing delivery services to pregnant women. It's been an inauspicious beginning for the lunar Year of the Dragon — a symbol of power and strength in Chinese culture that's typically associated with increased births. The closures are the latest in an alarming trend: More than a dozen hospitals closed their obstetrics wards in 2022 and 2023, according to local media. Data from the National Health Commission shows the number of public maternity hospitals dropped to 793 in 2021, from 809 two years before. Chinese government hasn't published nationwide statistics on the shrinking number of obstetric departments at hospitals. State media, too, has remained mostly muted on the topic.
With all the media reports and public attention, the National Health Commission on March 27 released a notice to address the issue. Institutions including maternity hospitals and major general hospitals should keep delivery services in principle. Public hospitals should seek feedback from pregnant women and local health authorities on their plans to shut down obstetric departments. The notice also urged hospitals to ensure obstetricians are earning no less than doctors working in other departments. That leaves us to wonder: Why are delivery options for pregnant women growing smaller? One reason could be the historically low birthrate we're seeing in China. Just over 9 million babies were born in this country of 1.4 billion last year, the lowest number since the founding of the People's Republic back in 1949. A short-lived rise in births in 2016 after the government relaxed its one-child policy gave way to a steady decline in recent years. India overtook China as the world's most populous nation in 2023, and the mainland's population has shrunk for two consecutive years. Then there's the wards' financial burden: Unlike in the US, where it can run tens of thousands of dollars to deliver a baby, fees are usually low in China's state-run hospitals — versus high 24-hour operating costs. One new mom in Shanghai shared on Chinese social media that it cost her just about 9,000 yuan ($1,200) to have a natural birth, including fees for her epidural and two nights' stay in a double room after delivery. China further eased its policy in 2021 to allow up to three children per household. And it's been ramping up policies to encourage people to have kids, including offering subsidies and longer maternity leave. Still, young couples are grappling with an economic environment that's dissuading some from having families, including a property slump and employment uncertainties. So where do we go from here? The wards' closures are raising concerns among medical professionals who've seen the hectic workloads and low incomes of doctors and nurses in obstetrics departments, and more and more young doctors are opting out of the field. Duan Tao, a professor and director of obstetrics at Shanghai First Maternity and Infant Hospital, recently took to social media with a plea to save obstetrics as a specialty. The practice is in a downward spiral with no clear bottom in sight, Duan said in a post on Weibo, China's X-like microblogging service, urging support like higher medical fees and salaries for doctors. "Who's going to deliver babies if no one wants to be an obstetrician?" Duan asked. —Karen Leigh | 
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