An infertile couple in Guangzhou recently managed the fairly spectacular feat of having eight children over the course of two months. This was made possible by hiring two surrogate mothers, and spending upwards of 1,000,000 RMB on an in vitro fertilization (IVF) treatment. The mother herself gave birth to triplets, while the two surrogate mothers produced another five children between them. Although the use of surrogates is illegal in mainland China, the births took place in Hong Kong. This story, partially because of the family's eightfold disobedience when it comes to the one-child policy, became a global news item that no one quite knew how to react to. The Daily Mail, so frequently a strident critic of the UK's so-called "benefit cheats" families (who have as many children as possible to garner more welfare support), suggested that the case has "made a mockery of China's one-child policy".

Ever since the first successfully implemented IVF treatment in 1978, the technology has proved a fertile breeding ground for ethical debate. In Western countries, religious objections have accompanied the practice since its inception. In China, although qualms over the implications of ‘man playing God' are absent, the technology has recently enlivened a very different kind of discussion. Reproductive-assisted technology provides a means, at least for the wealthy, of bypassing the one-child policy, and medical technology threatens to further complicate what is already a murky labyrinth of social and economic issues.

1)IVF in China

IVF was at first treated with suspicion in China—a technological means of giving birth seemed an obvious threat to the very core of the family planning policy. Yet the first "test-tube baby" was born in 1988, and by the mid-1990s, awareness of infertility issues led to a general acceptance that every family should be able to have a child. This kind of development was made possible through the general improvement of healthcare facilities and technology, and an increasing shift in social attitudes; very little of the religious stigma that afflicted Western health-assisted reproduction was present in China. There were only five private centers offering assited reproductive technology (ART) procedures in 2001, but this figure has now risen to well over 200; IVF clinics in cities such as Shanghai are now overrun with patients. After the Sichuan earthquake in 2008, the government offered IVF treatment to the parents of the 7,000 children who lost their lives in the tragedy.

The World Health Organization estimates infertility to be the third most serious disease in the world, after cancer and cardiovascular disease. In China, it appears to be on the rise. In 2010, surveys suggested that up to 10% of couples frequently having sex were unable to conceive within a year—one of the standard medical definitions of infertility. In the 1980s, this figure was estimated to be as low as 3%. Although statistical analysis in China is always to be taken with a pinch of salt, a number of social factors associated with infertility, such as previous abortions and a rise in the average age when women get pregnant, may have contributed to this trend. Further, factors such as urbanization, with its associated higher levels of stress, may also play a role in infertility's status as a health issue. As infertility rises, the use of treatments such as IVF will similarly rise, as it has over the past two decades. This change not only impacts on the one-child policy directly, by providing a tool for giving birth, but it also raises questions about the policy itself.

2)One-child Policy

Around 20% of successful IVF births in China result in multiple births, and there is a strong possibility that many individuals in China are using the technology to bypass the one-child policy. An increasing consensus on the negative consequences of the policy may be a factor in parental decisions to try to have twins or triplets.

In late 2012, a Chinese government think-tank report was published that advised phasing out the one-child policy over the next few years. The policy has come under the spotlight yet again over the last week. A study published by Science claims that the one-child policy has produced "significantly less trusting, less trustworthy, more risk-averse, less competitive, more pessimistic, and less conscientious individuals." Such conclusions were drawn on the basis of an experiment comprising 421 Chinese individuals born just either side of the 1979 one-child milestone. The subjects participated in a series of co-operative games designed to test for altruism and other such characteristics, and found a significant difference between the two cohorts.

3)Changing attitudes

Much has been written on the social impact of this so-called Little Emperor syndrome. Yet the developments of IVF set the one-child debate at a new tangent. As with media coverage of the Guangzhou couple, almost any mention of childbirth in relation to China will immediately trigger opinion and predictions about the one-child policy. IVF and the one-child policy came around at an eerily similar time, in 1978 and 1979 respectively, yet they embody profoundly different attitudes to individual control over their own reproductivity; the former helping those unable to reproduce, and the latter restricting those who could. The use of IVF as a tool to bypass the one-child policy is expensive, but more and more Chinese families have the economic means to take advantage of it. Furthermore, as infertility looks set to worsen, and the social and economic negatives caused by the one-child policy become truisms, IVF in China is an increasingly important aspect of healthcare in China, especially as healthcare is so radically developing. Its trajectory over the last several decades is a symbol of China's capacity for reform, and of the Chinese population's growing discontent with the one-child policy.

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Keywords: In vitro fertilization in China Guangzhou octomom infertility in China