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.

The growing normalization of cosmetic procedures is reshaping how many women approach appearance, ageing and professional identity, according to consumers and experts who describe a shift from treatments once associated with wealth and exclusivity to services increasingly marketed as routine aspects of personal care.

The expansion of aesthetic treatments beyond specialist cosmetic clinics into settings such as dental practices and shopping centres has contributed to their wider acceptance, reducing barriers to access while altering public perceptions of who uses such services and why.

Dr. Jasmine Fardouly, a senior lecturer in psychology at the University of Sydney, said the broader availability of cosmetic interventions has changed the way they are viewed by consumers. Procedures that were once considered luxury purchases have increasingly been presented alongside everyday beauty and grooming services.

According to Fardouly, the growing accessibility of treatments has weakened their association with exclusivity while positioning them as ordinary consumer decisions comparable to other appearance-related expenditures.

At the same time, she noted that cultural attitudes toward appearance remain complex. While aesthetic procedures are increasingly accepted, debates continue over the amount of time, money and attention women devote to maintaining their appearance.“I think there is also a pushback against the amount of money and time women place on their appearance,” Fardouly said.

“It can create a class divide in that only women who can afford these procedures can meet these ideals.”Her comments reflect broader questions about affordability and access. As cosmetic procedures become more common, the financial commitment required to maintain regular treatments remains significant for many consumers.

For some women, aesthetic interventions are viewed as part of a progression of personal care practices that begin early in adulthood and evolve over time. Munson, a relief teacher, described cosmetic treatments as an extension of routines that initially included services such as eyebrow waxing and facial treatments.

She said the cost of maintaining cosmetic procedures is substantial relative to her income. According to Munson, a single day’s wage as a relief teacher is sufficient to cover only one Botox treatment.“It is a big number for us, but my partner looks after the household,” she said.

Munson explained that she sees cosmetic procedures as part of a broader pattern of appearance-related maintenance that has become normalized across different stages of life.“I remember as a teenager going to get my eyebrows waxed. As you get older, you hit 20, you start doing some more intensive facials. This is just what you do,” she said.

Her experience illustrates how aesthetic procedures are increasingly integrated into established beauty routines rather than being regarded as exceptional or uncommon choices.The trend is also evident among professional women who view cosmetic treatments as serving practical as well as personal purposes. Tania Zanetich, a 45-year-old finance professional, said she has observed a growing number of friends and colleagues using aesthetic interventions, regardless of age, cultural background or income level.

Speaking about her social circle, Zanetich said cosmetic treatments now appear across a broad spectrum of consumers, although approaches vary considerably.“I’ve got friendships with women from all cultures, all ages and budgets and girlfriends with big lips, who look like they’ve had work done and want the perception of wealth, and some of us that are very subtle,” she said.

Zanetich said she began receiving Botox and filler treatments in her mid-thirties. Her initial motivation combined medical and cosmetic considerations, including headaches and concerns about developing facial lines.“It was positioned to me as preventative of ageing, while also helping me clinically and I enjoyed the benefits,” she said.Over time, she said, the role of these treatments expanded beyond appearance alone. In her view, cosmetic procedures can influence how individuals perceive themselves and how they believe they are perceived by others in professional environments.

Zanetich described confidence and presentation as important factors in corporate settings, where personal appearance can become intertwined with broader perceptions of professionalism.“Joking the other day with my accountant, I said, surely Botox should be a tax deduction, because at work, I look like I can’t frown,” she said.She added that maintaining a composed appearance can influence workplace interactions.“If someone says something in a meeting, I’m looking poised,” she said.

“I think in a corporate workplace, if you are a mother of two small children, when you present yourself with a certain decorum, that image translates to a level of competency that might extend to my ability to do my job well.”Such observations highlight the evolving role of cosmetic procedures in professional contexts. While aesthetic treatments are often discussed in relation to beauty standards, some consumers increasingly describe them as tools that support confidence, self-presentation and workplace identity.

The debate surrounding cosmetic interventions remains highly polarized. Public discussions frequently frame women as either embracing or rejecting aesthetic treatments, creating contrasting narratives around authenticity, ageing and self-expression.However, the experiences described by consumers suggest a more nuanced reality.

Rather than viewing procedures solely through the lens of vanity or resistance to ageing, many women describe making decisions within a broader set of social, economic and professional considerations.The mainstream adoption of cosmetic procedures also reflects longstanding pressures associated with appearance.

As treatments become more accessible, they are increasingly framed as matters of individual choice, even as broader societal expectations continue to influence decisions about beauty and ageing.For some women, the emotional benefits associated with cosmetic procedures can outweigh concerns about cost.

Zanetich said she has encountered women who place significant value on the confidence they derive from treatments, viewing them as an important component of their wellbeing and daily functioning.“Women around me say, ‘if I had to choose between my Botox or buying groceries, I would cut back on groceries’ because of how it makes them feel, and how they are able to tackle the day to day,” she said.

Despite differing opinions on cosmetic interventions, Zanetich argued that women face sufficient scrutiny from society without additional judgment from one another.“I don’t judge anybody,” she said. “I think society judges women enough for us to judge each other.”