For decades, reproductive policy in China was closely tied to state objectives, with authorities first seeking to limit births through the one-child policy and now attempting to encourage larger families as the country confronts a sustained decline in births.Interviews with women across China, combined with academic research and demographic data, suggest that the legacy of the one-child era continues to influence family decisions even as government priorities have shifted.

While authorities now promote childbirth through subsidies and policy incentives, many women cite economic pressures, changing social expectations and personal autonomy as key factors shaping their choices.Since the founding of the People’s Republic of China in 1949, family planning and population management have played a significant role in public policy.

During the decades-long one-child policy, which was formally implemented in 1980 and largely ended in 2016, many families were restricted to a single child. Enforcement methods varied across regions, but reports from several parts of the country documented fines, mandatory birth-control procedures and, in some cases, forced abortions and sterilizations.

In Shen County, located on the outskirts of Liaocheng in eastern China’s Shandong province, memories of some of the most stringent enforcement measures remain vivid among older residents.One woman in her 60s, identified only by the surname Li, recalled being subjected to a tubal ligation after giving birth in 1991. According to Li, local authorities were enforcing what became known as the “childless 100 days” campaign, a policy intended to prevent births during a designated period beginning in May of that year.

Li said she was heavily pregnant when local officials transported her and other women to a hospital for procedures intended to terminate pregnancies. She said she went into labor before doctors could carry out the abortion and gave birth to a son inside the hospital.

Afterward, she was fined 6,500 yuan and ordered to undergo sterilization.The Guardian was unable to independently verify all aspects of Li’s account. However, researchers and activists familiar with the period say similar reports emerged from the region during that time.Another Shen County resident, now in her 70s, said she was one month away from giving birth when she received an injection that induced labor and ended her pregnancy.

She said women who resisted family-planning directives faced threats that included property demolition, detention and restrictions on employment.Shandong, China’s second-most populous province, has long been viewed by scholars and activists as a region where central government policies were often implemented rigorously.

Human rights activist Yang Jianli, who is originally from Shandong, described the “childless 100 days” campaign as one of the most extreme examples of one-child policy enforcement that he had encountered.The Shandong provincial government did not respond to a request for comment regarding the historical accounts.

Although comprehensive data on the campaign are unavailable, demographic analysis by Yi Fuxian, a senior scientist at the University of Wisconsin-Madison and a longtime critic of China’s population policies, indicates that birth numbers in Shen County and neighboring Guan County fell sharply during the period in question.

More than a decade after China began dismantling birth restrictions, policymakers face a different demographic challenge. China’s birth rate has continued to decline despite efforts to encourage larger families. Official data show that the birth rate fell to 5.63 births per 1,000 people last year, marking a record low.

The government has introduced a range of measures aimed at increasing births, including financial incentives and tax benefits. However, researchers say economic realities and evolving attitudes toward family life have limited the effectiveness of those initiatives.A growing body of academic research suggests that decades of restrictive family-planning policies reshaped social expectations about ideal family size.

One study published last year found that growing up as an only child contributed to a significant reduction in the number of children people expected or desired to have.For many younger Chinese adults, concerns about housing costs, education expenses and financial security appear to outweigh policy incentives.Wang Yixuan, a 26-year-old practitioner of traditional Chinese medicine, said she does not currently plan to have children.

She said achieving financial independence remains a higher priority.Jia, the filmmaker based in Beijing, said women today possess greater freedom in making decisions about reproduction than previous generations. She said many no longer view motherhood as an obligation and increasingly approach family planning as a personal choice.Recent survey data point to a significant shift in attitudes among younger women.

One study found that nearly half of women aged between 18 and 24 reported that they did not want children, compared with just 6% in 2012. The proportion of men expressing the same view also increased during the period, although at a lower rate, reaching nearly 20%.In Shen County, restaurant worker Chen Ying said economic considerations play a decisive role in family decisions.

While earlier generations faced penalties for having additional children, she said many families today are limiting family size because of the financial burden associated with raising children.Yun Zhou, a social demographer at the University of Michigan, said the one-child policy left a lasting imprint on perceptions of reproductive rights and family planning.

According to Zhou, generations of state intervention contributed to a broader understanding that reproductive decisions were subject to government influence rather than being viewed solely as personal choices.

The effects of those decades remain visible across China, where a generation raised largely as only children is now making decisions about marriage, parenthood and family size under a dramatically different demographic reality.

For years, she wanted a child. After a decade of waiting, hope and uncertainty, pregnancy finally arrived carrying both joy and fear in equal measure. What followed, however, was not the soft, instinctive transition into motherhood that culture often promises, but a physically traumatic birth, emotional numbness and a long struggle to recognise herself in her new life.

During pregnancy, she found herself largely alone. Her husband, though supportive and loving, was frequently absent, consumed by the demands of a startup consultancy he had recently founded with two academic partners.

Medical appointments, including an amniocentesis prompted by concerns over possible chromosomal abnormalities, were often faced without him because he was abroad for work.

She attended prenatal classes, but support systems felt limited. Only one person in her close circle had children, and her relationship with her own mother, who lived in Italy, was strained. The isolation deepened her anxiety, particularly because childbirth itself frightened her.

When she raised those fears with her general practitioner, she recalls receiving a familiar reassurance that did little to ease them.“Don’t worry, birth isn’t an illness,” her male GP told her. “It’s all perfectly natural.”She felt the dismissal ignored her lived reality. She was asthmatic and suffering from undiagnosed endometriosis that caused severe pain every few weeks.

Pregnancy did not feel simple or natural. It felt uncertain and medically significant.Still, she felt deeply connected to the child growing inside her. She recognised her daughter through movement alone—the shape of limbs pressing against skin, strong kicks in response to passing sirens, a physical presence both strange and intimate.

She imagined a temperament already forming: long legs like her father, a temper like her own.She expected love to be immediate. After waiting so long, how could it not be?Her due date passed. Then another week.

Then another. At more than 44 weeks pregnant, she says she had to insist repeatedly before her GP agreed to induction. Only when hospital monitoring showed signs of fetal distress did medical staff finally intervene and break her waters.

Labour lasted 20 hours.

She describes induced labour not as a gradual progression but as a sudden collapse into nausea, pain and exhaustion. Hours passed with no progress. She was unable to receive an epidural at first because she was not dilating. The pain became all-consuming.

At one point, fearing the worst, she asked her husband to make a promise: if doctors had to choose between saving her life and their child’s, he should choose the baby.“I am not going to lose either of you,” he replied.

She remembers University College Hospital at the time as a place that inspired little confidence—a crumbling Victorian building with filthy bathrooms, blood on the floors and junior doctors exhausted by punishing shifts. Around her, the maternity ward echoed with the sounds of women in labour: groans, cries, gasps and fear.Eventually she received an epidural, but the baby remained stuck.

Just before midnight, an emergency forceps delivery and episiotomy were performed. Her husband later told her there were 13 people in the room.Then their daughter arrived.She weighed just under 4.5 kilograms—almost 10 pounds.

The mother had lost so much blood that the experience felt, in her words, like surviving a car crash. Her husband, standing in blood-soaked jeans, was overwhelmed with joy.“Isn’t she wonderful?” he said.She felt nothing.

She describes the absence of emotion not as rejection, but as total numbness, as though the epidural that had numbed her body had also severed access to feeling. She spent the night awake in the recovery ward waiting for the expected rush of maternal love that never came, listening to other women crying as anaesthesia wore off.

Instead, she felt transported back to boarding school dormitories, where she had learned early to suppress everything except anger.“Rage has served me quite often as a stimulant against exhaustion,” she writes. “Every woman who goes through childbirth has, I believe, been through the equivalent of war.

”She compares childbirth to trauma rather than celebration, arguing that many women leave the experience carrying symptoms closer to post-traumatic stress than to joy.

She believes poor maternity care intensified that reality.Her experience took place during years of severe strain on Britain’s National Health Service, when long-term underfunding and overstretched staff affected standards of care.

But she also sees a broader cultural issue: motherhood itself, she argues, is often insufficiently respected.At the time, general practice and obstetrics were still dominated by men.

She does not argue that male doctors cannot provide excellent care, but believes many failed to understand how dangerous childbirth could still be, or how often women’s pain was normalised rather than addressed.She was discharged the next day after a blood transfusion and severe physical trauma. She could barely walk.

Her husband worried about her physical recovery, but neither of them recognised the mental damage taking shape beneath it.When the baby began crying—night after night, almost without pause motherhood became a contest between exhaustion and fury.

“Once our baby began to cry relentlessly every night, all night, it felt like a battle between my rage and hers,” she recalls.Then one day, something changed.Her daughter, whose eyes had until then seemed distant and unfocused, suddenly looked directly at her. Then came a smile—clear, unmistakable and full.It was not simply recognition. It felt like acceptance.

“She seemed not only to recognise me, but to greet me with unconditional love and delight,” she writes.She understood intellectually that infant smiles are biological survival mechanisms, but the emotional impact was overwhelming.

The joy felt so sharp it was almost painful.“Oh!” she remembers saying. “It’s you. It’s you.”That first smile altered everything.The sleepless nights did not disappear. The crying continued. But something fundamental shifted in her understanding of motherhood, of love and even of her own mother.

Her relationship with her mother, long marked by pain and distance, softened. She began to understand her mother’s own unresolved grief and emotional absences not simply as cruelty, but as the result of childhood bereavement and wounds never healed.Motherhood brought not only responsibility, but perspective.

As a writer, she found that literature had offered little preparation for the reality of childbirth. Victorian novels she loved moved quickly past pregnancy and motherhood, treating them as narrative transitions rather than lived experiences.

Even contemporary women writers often avoided describing the devastation of birth itself.When she included the physical brutality of childbirth in her 1996 novel A Vicious Circle, critics attacked what one reviewer called “revolting details.”

Yet she says she had still softened the truth, giving her fictional heroine an instant maternal bond she herself had not felt.Years later, much changed. Hospitals improved. Her GP practice became staffed by younger, mostly women doctors. She had a second child, a son, whose birth was entirely different and with whom she bonded immediately.

Her daughter, Leon, grew into a novelist herself—healthy, loving and brilliant.Looking back, she says motherhood brought both unimaginable suffering and extraordinary love.

Public conversation often reduces it to either sentimental joy or unbearable hardship. The truth, she argues, is both.And if the early days felt like darkness, what remained was not the trauma alone, but the light that followed.