Zhao Zihuan, a first-time mother in the Chinese city of Jinan, had two miscarriages before giving birth to a son last year. The seven-hour labor ended in an emergency Caesarean section.

Exhausted by child care, the 32-year-old and her husband decided one kid was enough — so in April they began to inquire about a vasectomy. Yet they were turned down by two hospitals. One doctor told Zhao’s husband that the surgery was no longer allowed under the country’s new family-planning rules.

“I was frightened and angry at the same time,” said Zhao, who works in publishing. “What if we accidentally get pregnant? We won’t have a choice but to have the child. The burden will be too great.”

For more than three decades, Chinese authorities forced men and women to undergo sterilization to control population growth. Now, as the government tries to reverse a plummeting birthrate that it fears could threaten social stability and the economy, hospitals are turning away men seeking vasectomies.

“It’s a rather simple surgery in theory, but public hospitals will almost always turn patients away because we are aware of the risks involved in doing something that’s not explicitly OK’d by the government,” said Yang, the director of a hospital in Jingzhou city, Hubei province, who gave only part of his name for fear of punishment for speaking to foreign media. “The fundamental policy is that China needs more childbirths.”

China recorded 8.5 births per 1,000 people in 2020, the lowest rate in more than 70 years, according to official data released in November. With one of the world’s lowest fertility rates — at 1.3 children per woman, it is below Japan’s — demographers predict China’s population could begin to fall within a few years.


Yet efforts to arrest the trend — including loosening family-planning rules such as the former one-child policy, and offering cash subsidies and longer parental leave to encourage larger families — have failed as more Chinese couples choose not to have children.

Chinese family-planning law says citizens’ reproductive rights, including choosing birth control, are protected. There is no official ban or specific restriction on the surgery, though hospitals and doctors conducting vasectomies, along with tubal ligations and abortions for women, must be approved by county-level health departments. The National Health Commission did not respond to faxed questions.

The worry for some couples is that authorities could turn to more forceful or restrictive measures akin to those used to enforce the one-child policy. Guidelines released by the State Council in September said local governments should try to reduce the number of abortions for “nonmedical reasons.”

Twelve public hospitals contacted by The Washington Post, including facilities in Shanghai, Beijing and Guangzhou, said they no longer offered the procedure. Six hospitals said they still perform the surgery, but one said it was no longer available to unmarried men.

Couples and single men who sought the procedure said doctors and hospital staff refused, telling them they would regret the decision later. Some asked for documentary proof of marriage and evidence that couples had already had children before going ahead with the surgery.

Zhou Muyun, a 23-year-old copywriter in Guangzhou, tried unsuccessfully to get a vasectomy this year. He and his girlfriend Han Feifei, a graduate student in mass communications, had moved in together, and wanted to maintain a “DINK” — double income, no kids — lifestyle.


“The more I learn about vasectomies, the surer I feel about my decision. We want to have sex, not children,” Zhou said, noting that the procedure poses fewer complications than female sterilization.

Zhou was turned down by two hospitals, with doctors telling him that he was too young.

“Having a child or not is our choice to make and our fundamental right. We don’t need anyone to tell us how to live,” he said.

During the one-child-policy era, vasectomies were often seen as taboo in China. But they were more common in some provinces, such as Sichuan, Henan or Shandong, where officials more aggressively pushed the procedure.

As the government loosened family-planning rules, the number of vasectomies performed fell from 149,432 in 2015 to 4,742 in 2019, according to official data. China implemented a two-child policy in 2016.

Some Chinese scholars say surgical ligation has not been banned, but discouraged, especially after authorities announced in May that all couples could have three children.


“With the three-child policy in place, doctors have new, longer-term concerns. Performing the surgery on a man in a family-oriented society means depriving them of the chance to have children and grandchildren,” said Sun Xiaomei, a gender studies professor at China Women’s University in Beijing. “No one wants to be blamed for that.”

After the three-child policy was announced, Zhao and her husband felt a greater sense of urgency to get his vasectomy done, fearing further restrictions on abortion or access to contraceptives.

Jiang, 30, who works in customer service at an internet company, visited six hospitals in his home province of Fujian before finding one more than 1,200 miles away in Chengdu in Sichuan province that would perform a vasectomy. After his surgery in March, he posted the clinic’s details on an online forum — but heard from another user that the hospital had since stopped offering the surgery.

“I felt like I had finally gotten rid of this huge burden,” said Jiang, who did not disclose his full name out of security concerns for criticizing government policy. “Those around me who are married and have kids have nothing that makes me envious.”

The discouragement of vasectomies reflects traditional views that women should bear the burden of birth control. When Zhou and his girlfriend inquired about getting a vasectomy, a doctor suggested that his girlfriend wear an intrauterine device.

“This reflects a long patriarchal tradition,” said Yue Qian, an associate professor of sociology focusing on gender and demography in China at the University of British Columbia. “Men are never put at the center for issues related to marriage, family, fertility and birth control.”


That may be changing. A popular online personality, Yuan Fang, a teacher in Zhejiang province who comments on family and gender issues, took to the video-streaming platform Bilibili in October to describe his experience getting a vasectomy.

Zhao and her husband eventually found a doctor at a smaller public hospital outside Jinan who would perform the procedure. Even on the operating table, the doctor tried to discourage him from going ahead.

“I already said I want to do it. I’m really doing it,” Zhao’s husband recalled telling the doctor. Declining to give his name out of privacy concerns, he added: “In the end it’s us, not the government, that has to bring up a child.”