China's Population Is Shrinking. What Happens Next?

Recently, the Chinese government announced a change to their family planning directives: they will now allow families to have three children, up from a two-child policy enacted in 2016. This, of course, replaced the one-child policy that had been in place since 1979. As mental health professionals, we must ask ourselves what this will mean for the future of the Chinese family, for population growth (or not), and for the mental health of the Chinese families we serve.

The one-child policy that ruled Chinese family planning for more than three decades turned out to be disastrous for China’s demographics. A massive gender imbalance gradually took shape, with between 118-130 men for every 100 women. This left many poor rural men without any chance of marriage: a personal and public problem of staggering proportions. Many Chinese people deeply regret being constrained to having only one child, but gradually this also became a cultural norm.

The one-child policy resulted not only in a gender imbalance, but a population imbalance as well. China now faces an aging — and diminishing — population; the country is expected to peak at about 1.4 billion and start to fall. Already, we see China’s young adults saddled with caring for their aging parents in a population where there are simply not enough people of working age to do so. China’s age imbalance is the worst in the developed world.

This is why the government is not just allowing families to have more children, but imploring them to do so. Now the question is: Will China’s population rise to this call? The answer seems to be a resounding “No.”

In my extensive work in China, I know of families with multiple children — there were ways to get around the one-child policy for the relatively well-off — but most families found the silver lining with having smaller families: fewer children meant lower household expenses and fewer impediments to career goals. Now, many women have put off getting married and a sizable minority say they do not want children at all. The current rate of childbirth is about 1.5 children per woman, well below replacement rates for the population. This trend is emerging in nearly every developed country.

In essence, then, the government’s corrective policies are too little and too late. We hear many women asking the government to stay out of their lives: “First you told us we can only have one child. Now you tell us it is patriotic to have two (and now three). It is our business, not yours!” The desire for smaller families began as a collectivistic vision, but the irony is that it now continues as an individualistic one.

All of these changes have direct implications for mental health, of which psychologists and mental health professionals would be wise to take heed:

• Insular behavior. Many Chinese millennials grew up without siblings; the younger generation may have even fewer peers in their homes and communities. This may lead to a preference for smaller social groups, fewer social activities, and individualistic pursuits.
• Interfamily power dynamics. As young adults struggle to take care of their children, they often rely on their parents for help. Because of the closeness borne of the one-child policy, however, this can lead to family conflict about whether the parents or grandparents are in charge.
• Gender equality. Traditional large families, dominated by sons and fathers, have been transformed into families dominated by their one child; if it is a girl, she is usually valued just as much as sons were formerly.
• Estrangement. China’s only children will have to take care of their aging parents, and if that relationship is toxic — or if the only child has died — the aging parents are at risk of economic hardship, loneliness and depression.

All of this requires mental health support in a country where the formal mental health service landscape is only 30 years old. Psychotherapy and counseling are growing fields, but they have not yet spread to rural areas where the need is greatest. When we add in the in-migration of rural families to the cities without social support, networks or schools, we begin to see indications of a brewing mental health crisis that is just as important to China’s future as its politics, treatment of the environment and economic development. As China wrestles through the growing pains of population policy reversal, it is incumbent on mental health professionals to bear these changes in mind.