Simple Solutions Create Complex Problems: Fertility Decline and the Effects on Eldercare in China 

China’s history is rife with examples of faulty problem-solving based in simplistic assessments culminating in oversimplified solutions with far-reaching disastrous results. The Great Leap Forward was intended to make China a first-world power through expedited industrialization. The result: a nationwide famine. The Cultural Revolution which sought to spread new ideology led to bloodshed and a lost generation of academics. In addition, China has attempted to remedy economic problems through manipulation of its population. This approach has not addressed the intended problem; instead, it has introduced more complications, especially regarding eldercare.

This paper will focus on problems in eldercare that have arisen due to the One Child Policy, the obstacles to resolving these problems, and recommendations for better approaches.

China’s Choice to Regulate Its Population

China has attempted to increase economic growth through population control since the 1950s. According to Daniel Goodkind (2017), Mao believed an increased population was the key to China’s economic success. This led to a total fertility rate of approximately six births for every woman.

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However, when the economy stagnated in 1969 with China’s population surpassing 800 million, China chose to focus on overpopulation as the cause of economic distress instead of re-evaluating its economic institutions (Zhang, 2017). Then Mao himself began calling for population reduction policies (Zhang, 2017).

This led to the Later, Longer, Fewer (LLF) campaign enacted around 1975 (Abrahamson, 2016), which was the precursor to the One Child Policy. The LLF successfully reduced the total fertility rate “from almost six births per woman in 1970 to less than three by the late 1970s” (Goodkind, 2017, p.

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1377). The 1980s ushered in the aggressive One Child Policy, as according to Song and Li (as cited in Goodkind, 2017, p. 1377) a reduction in fertility rate to just “three births per woman” would still result in a population close to 3 billion a little more than a half-century later. However, during the mid-2010s, a drop in economic growth “from around 10% to around 7%” (Abrahamson, 2016, p. 327) triggered the abandonment of the One Child Policy.

Negative Effects on Eldercare

None of the population controls have been an effective economic solution. In fact, the One Child Policy has exacerbated problems. One area it has most affected is the care of the elderly. The policy is linked to negative effects: a lowered fertility rate and subsequent “artificially large elderly demographic” (Nie, 2016, p.352), an increased burden on family caregivers, and a rise in the rate of elderly suicide (Nie, 2016).

Obstacles to Problem Resolution

Several factors make finding solutions difficult. Historically, China’s eldercare was provided by the wife of the eldest son (Abrahamson, 2016). Now, the expectation for the younger generation to provide care for their parents has become a legal obligation. According to Nie et al. (2017), a law passed in 1996 legally reinforced this long-lived tradition. Children are now obligated on both cultural and legal grounds to provide care for the older members of their family. To complicate matters women are increasingly moving to urban areas for employment opportunities (Abrahamson, 2016).

Therefore, according to Pei et al. (2017), “family caregiving is undermined by the labor mobility of adult children” (p. 359). Abrahamson (2016) explains the cause of this mobility: China’ economic shift from a planned economy, where enterprises were mostly state-owned, to one that resembles a market economy. Thus, it is more common for younger individuals to move to urbanized areas for work, often making it physically impossible to serve as a family caregiver. The support these adult children can provide is limited to financial support.

This situation is exacerbated by what Abrahamson (2016) describes as the “4-2-1 family structure…where they [the children will] have to shoulder the care of four grandparents and two parents when they come of age” (p. 326). Not only is the future responsibility of the only child massive, the senior members of the family are placed in a precarious position: their hope for aid in their old age rests primarily on one individual.Therefore, the implications of losing this one child are disastrous. The issue is so grave that Jing-Bao Nie (2016) describes a whole new set of Chinese vocabulary recently created for the purpose of describing the members of a family who have lost their only child.

Jing-bao Nie (2016) identifies another cultural and legal situation that obstructs the provision of better eldercare and relief for caregivers. Nie (2016) notes that welfare payouts are already far lower, on average, than the amount spent by states in similar economic situations, despite being in a financial position to increase aid. In addition, Zhao (as cited in Nie, 2016) states that “although total expenditure on health care and social welfare has been increasing yearly” (p. 358) it still falls short.

Not only are the payouts low, there is discrimination in their distribution. A system of household registration, known as hukou in Chinese, enforces this inequality. According to Nie (2016), “the system divides Chinese into two civil status groups ascribed at birth places: rural and urban” (p.360). Discrimination between these groups pervades every facet of their lives, with those marked as urban favored when it comes to healthcare and welfare payouts. Tatlow (as cited in Nie, 2016) encapsulates the extent of this disparity: “[The] pension for a non-state employee in Beijing may be 3000 Chinese yuan or more per month; but it can be only 80 or less for a person in rural areas,… if he or she has any pension at all” (p. 361). The devastating effect is a higher rate of elderly suicide in rural areas (Nie, 2016).

Recommendations to Solve the Eldercare Issue

To address the problems in eldercare, the Chinese government should take several steps to bring resolution. Both Pei et al. (2017) and Nie (2016) provide suggestions for policies and government actions China must implement to confront the current eldercare crisis. Because the problem is two-sided, with the elderly and the young affected, a two-sided approach is necessary. On the side of the adult children, Pei et al. (2017) believes “development of the welfare system should include feasible programs that provide direct assistance to caregivers in the labor market” (p. 369)

Nie (2016) outlines a number of solutions to confront the eldercare issue from the side of the aging population. Recognizing the minimal efforts made to increase welfare payout to aging Chinese, Nie (2016) believes government action should be taken to “significantly and steadily increase the percentage of GDP in healthcare and social security” (p.362). In addition, the hukou system should be removed, as it “segregated rural people from urban residents as two classes of citizens” (Nie, 2016, p. 362) and enabled justification of unequal benefits. Nie (2016) also calls for specific action directed “to further develop healthcare and eldercare in rural areas” (p. 362). Finally, and perhaps most urgently, a commission should be created with the purpose of creating “social policies and social and healthcare programs to prevent elderly suicides” (p.362).

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Simple Solutions Create Complex Problems: Fertility Decline and the Effects on Eldercare in China . (2021, Apr 03). Retrieved from

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