China's New Contraception Tax: Risks of Rising STDs and Unplanned Pregnancies Amid Population Growth Efforts

A panoramic view of Shanghai's skyline. (File)

Starting January 1, China will implement a value-added tax on contraceptive products and drugs for the first time in over 30 years, aligning with Beijing's strategic efforts to boost birth rates after decades of restrictive family planning policies.

According to the nation's newest value-added tax legislation, "contraceptive drugs and products" will no longer enjoy tax exemption status. Items such as condoms will face the standard 13% value-added tax that applies to most consumer goods.

While the change has received minimal coverage in state media, it has sparked significant discussion on Chinese social media platforms. Many users have mockingly pointed out the obvious economic disparity between the cost of using contraceptives, even taxed ones, and the substantial expenses of raising children.

Health experts have raised significant concerns that the increased cost of contraceptives could potentially lead to a rise in unplanned pregnancies and sexually transmitted infections. This policy shift represents a dramatic reversal from China's former "one-child" policy, enforced from approximately 1980 until 2015 through substantial fines, penalties, and in some cases, forced abortions. Children born outside the quota were sometimes denied identification numbers, essentially rendering them stateless.

The government gradually relaxed restrictions, increasing the limit to two children in 2015 and then to three children in 2021, as China's population began to decline. During the restrictive era, contraception was widely promoted and easily accessible, often at no cost.

"That's a really ruthless move," remarked Hu Lingling, mother of a 5-year-old who firmly refuses to have another child. She jokingly claimed she would "lead the way in abstinence" as a form of protest.

"It is also hilarious, especially compared to forced abortions during the family planning era," she added.

Recent demographic data reveals that 9.5 million babies were born in China in 2024, approximately one-third fewer than the 14.7 million births recorded in 2019, according to the National Bureau of Statistics. This decline occurred despite a temporary uptick associated with the culturally auspicious Year of the Dragon in Chinese astrology.

With deaths surpassing births in China, India surpassed it as the world's most populous nation in 2023.

The tax policy's "effect on encouraging higher fertility will be very limited. For couples who do not want children or do not want additional children, a 13% tax on contraceptives is unlikely to influence their reproductive decisions, especially when weighed against the far higher costs of raising a child," explained Qian Cai, director of the Demographics Research Group at the University of Virginia.

Nevertheless, Yi Fuxian, a senior scientist at the University of Wisconsin-Madison, considers the tax implementation "only logical." He stated, "They used to control the population, but now they are encouraging people to have more babies; it is a return to normal methods to make these products ordinary commodities."

As in most societies, contraceptive responsibility in China predominantly falls on women. Research released by the Bill & Melinda Gates Foundation in 2022 indicates that condoms are used by merely 9% of couples, while 44.2% rely on intrauterine devices, 30.5% on female sterilization, and 4.7% on male sterilization. The remaining couples use oral contraceptives or alternative methods.

Given the government's historically intrusive approach to reproductive matters, some women find the new policy offensive. "It is a disciplinary tactic, a management of women's bodies and my sexual desire," said Zou Xuan, a 32-year-old teacher from Pingxiang in Jiangxi province.

While official statistics on China's annual condom consumption are unavailable, estimates vary. A report by IndexBox, an international market intelligence platform, indicated that China consumed 5.4 billion condoms in 2020, marking the eleventh consecutive year of increased usage.

Health specialists warn that decreased condom usage could exacerbate public health challenges. "Higher prices may reduce access to contraceptives among economically disadvantaged populations, potentially leading to increases in unintended pregnancies and sexually transmitted infections. Those outcomes could, in turn, lead to more abortions and higher health-care costs," cautioned Cai.

China reports one of the world's highest abortion rates, with 9-10 million procedures annually between 2014 and 2021, according to the National Health Commission. Experts suggest the actual figures may be higher due to unreported procedures at unregistered clinics. China discontinued publishing abortion statistics in 2022.

Sexually transmitted infections have shown an upward trend, despite a temporary decrease during the COVID-19 pandemic. In 2024, over 100,000 gonorrhea cases and 670,000 syphilis cases were reported by the National Disease Control and Prevention Administration.

The number of individuals living with AIDS and HIV has also increased, particularly among older Chinese citizens, reaching approximately 1.4 million cases in 2024.