Two-child policy poses risks for older women

Experts are warning that the country's new family planning measures could have unintended but far-reaching consequences

In recent years, the treatment of pregnant patients has become an increasingly thorny task for Liu Wenxian, a cardiologist at Anzhen Hospital in Beijing, as a result of the rise in the number of older women wanting to give birth.

"Many of these women are from outside Beijing and have risky complications, such as cardiac disease," she says.

"The problem has worsened since the adoption of the universal two-child policy because such complications are more commonly seen in pregnant women who have given birth before. In many cases - especially when the patient's condition is critical - we have to re-evaluate their decision to have a baby and end the pregnancy promptly to save their life."

Gu Hong, a pediatrician at the hospital who specializes in treating cardiac disease in babies, warns that the two-child policy could have unintended but far-reaching consequences: "We are facing some very harsh challenges. Many women are trying their best to have a second child, even if conditions such as cardiac disease could put them at high risk."

According to Gu, seven pregnant women have died in the hospital in the past five years as a result of cardiac complications, and those risks still exist despite improvements in medical technology.

Anzhen Hospital is not alone in facing the challenge.

According to the National Health and Family Planning Commission, in the first half of the year China's maternity mortality rate reached 183 per 1 million people, an increase of more than 30 percent compared with the same period last year.

The mortality rate had been declining steadily in China until the end of last year, when the country's leaders approved the adoption of the universal two-child policy to tackle the problems posed by the nation's rapidly aging population. As a result, the decadeslong family planning policy, which limited most couples to one child, was relaxed.

Last year, the mortality rate during pregnancy fell to 201 per 1 million people, from 300 per 1 million in 2010, according to the commission. But the figure is now rising.

"The rise in the number of pregnant women, particularly those at higher risk, such as older women, resulted in a rise in maternity deaths in some parts of the country in the first half of the year," a statement released by the commission in October said.

The NHFPC estimates that more than 3 million women at higher risk will become pregnant in China every year between the start of next year and 2020, a rise of 30 percent from the period before the adoption of the two-child policy.

"This will cause increased risks of maternity complications and present challenges to treatment and recovery," the commission said.

The number of babies born in the first half of the year was 8.31 million, a rise of 6.9 percent over the same period last year, a significant increase despite the declining number of married women of fertile age, it said.

In addition, the sudden rise in pregnancies has resulted in maternity services coming under greater strain, and both facilities and hospital personnel are under-resourced, according to the commission.

Of the 90 million women now eligible to have a second baby, 60 percent are 35 or older, which means they are considered to be at higher risk during pregnancy, the NHFPC says.

Gu says about 150 pregnant patients with cardiac complications were received by Anzhen Hospital last year, compared with approximately 110 in 2011. This year, the number is expected to surpass 180.

Acting on traditional beliefs, many women are opting to have another child, according to Gu: "Many of these patients are seeking treatment and care in our hospital, but not all women are suitable for pregnancy. Women with serious conditions are very likely to give birth to an unhealthy child, and their own lives could also be threatened during childbirth."

Liu, the cardiologist, urged older women to assess the risks they face before deciding to have a child.

"With the rise in age, pregnant women have a higher chance of developing illnesses. They must be aware of their physical condition before pregnancy to reduce the risk to them during childbirth," she says.

He Wenjie, a gynecologist at the reproductive medicine department at Xuzhou Maternal and Child Healthcare Hospital, in Xuzhou, Jiangsu province, has also seen a rise in the number of older patients: "The average age of patients I am receiving is rising. It is crucial that all women, especially those who are older, have checkups before pregnancy to reduce the health risk."

The NHFPC says health authorities will take more measures in the next few years to improve the health of pregnant women, given the rising rates of mortality during pregnancy.

Hospitals nationwide will add 89,000 obstetrics beds, and local authorities will upgrade emergency equipment at hospital obstetrics and pediatrics departments.

The commission will also select a number of national midwifery training bases and organize training related to the treatment of pregnant women with critical conditions.

It will also cooperate with other departments to provide training, with the aim of producing 140,000 extra obstetricians and midwives.

wangxiaodong@chinadaily.com.cn