Growing Old Under the One-Child Policy: Current Challenges and the Growing Need for Reform Student Name University of Maryland University College Since China enacted its draconian one-child policy nearly 40 years ago, the country has effectively curbed its explosive population growth, and simultaneously clawed its way into being the world's second-largest economy. However, in contrast to its benefits, the one-child policy has also caused a number of serious complications in China's modern society, namely a gender imbalance, a labor shortage, and, most importantly, a significantly accelerated aging society. As China pours almost all of its planning and resources into its future, the country has all but forgotten about the people who built it in the first place. Research into the effects of the one-child policy has typically focused on the younger or future generations of China. But now, more than ever, the challenges faced by China's aging population are at the forefront. The disparity between traditional eldercare and today's reality under the one-child policy spurred in part by massive internal migration, along with the severe impacts of inadequate care on the elderly population, clearly illustrates China's responsibility to reform its eldercare policies. Care for the elderly in China has traditionally been provided by each successive generation, with little to no support from the government. Lu, Liu, and Piggott (2015) defined this traditional familial care method as informal care, one of the pillars of the culture's long-term care structure. Through their research, Lu et al. found that there are many factors that determine if an elderly couple will receive long term care from their children, to include education levels and personal wealth. Additionally, they found that male children statistically gave more time and resources in care of their parents than female children, which may have been a factor of China's gender imbalance, another effect of the one-child policy. Finally, Lu et al.’s (2015) research revealed that the likelihood of receiving eldercare dropped significantly if the family had more than one child, a sharp contradiction towards many researchers' theories that more children would result in better long-term eldercare. Informal care as a long-term care option has always been the key to ensuring that the aging population of China is not neglected. China’s one-child policy has radically impacted the country’s demographic distribution, which, when combined with massive internal migration, has left millions of aging Chinese without care or support. As noted by Chen, Xu, Li, and Song (2018), the combination of lower mortality rates, increased life expectancy, and below-replacement fertility has accelerated China's aging society, heralding new challenges in eldercare for the country. The task of providing informal care, according to Lu, Liu, and Piggott (2018), has traditionally fallen onto the shoulders of younger generations, wi ...

1. Growing Old Under the One-Child Policy: Current Challenges
and the Growing Need for Reform
Student Name
University of Maryland University College
Since China enacted its draconian one-child policy nearly 40
years ago, the country has effectively curbed its explosive
population growth, and simultaneously clawed its way into
being the world's second-largest economy. However, in contrast
to its benefits, the one-child policy has also caused a number of
serious complications in China's modern society, namely a
gender imbalance, a labor shortage, and, most importantly, a
significantly accelerated aging society. As China pours almost
all of its planning and resources into its future, the country has
all but forgotten about the people who built it in the first place.
Research into the effects of the one-child policy has typically
focused on the younger or future generations of China. But now,
more than ever, the challenges faced by China's aging
population are at the forefront. The disparity between
traditional eldercare and today's reality under the one-child
policy spurred in part by massive internal migration, along with
the severe impacts of inadequate care on the elderly population,
clearly illustrates China's responsibility to reform its eldercare
policies.
Care for the elderly in China has traditionally been provided by
each successive generation, with little to no support from the
government. Lu, Liu, and Piggott (2015) defined this traditional
familial care method as informal care, one of the pillars of the
culture's long-term care structure. Through their research, Lu et
al. found that there are many factors that determine if an elderly

2. couple will receive long term care from their children, to
include education levels and personal wealth. Additionally, they
found that male children statistically gave more time and
resources in care of their parents than female children, which
may have been a factor of China's gender imbalance, another
effect of the one-child policy. Finally, Lu et al.’s (2015)
research revealed that the likelihood of receiving eldercare
dropped significantly if the family had more than one child, a
sharp contradiction towards many researchers' theories that
more children would result in better long-term eldercare.
Informal care as a long-term care option has always been the
key to ensuring that the aging population of China is not
neglected.
China’s one-child policy has radically impacted the country’s
demographic distribution, which, when combined with massive
internal migration, has left millions of aging Chinese without
care or support. As noted by Chen, Xu, Li, and Song (2018), the
combination of lower mortality rates, increased life expectancy,
and below-replacement fertility has accelerated China's aging
society, heralding new challenges in eldercare for the country.
The task of providing informal care, according to Lu, Liu, and
Piggott (2018), has traditionally fallen onto the shoulders of
younger generations, with parents and grandparents expecting to
be cared for by their grown-up children. However, the
demographic shifts under the one-child policy have strained the
younger generations ability to provide ample care and support.
A large portion of China’s younger population struggles to
balance the cultural idea of filial piety, expressed in part by
long-term care provision, with societal realities in modern
China (Glass, Gao, & Luo, 2013). Gui and Koropeckyj-Cox
(2016) found that many of China's youth felt as though their
identities as only children placed them in a unique position to
be the sole provider and caregiver, but struggle with the reality
of providing that care. They wrote that "the conflict between
work and family roles has become a major source of concern in
their lives and has contributed to eroding traditional family

3. arrangements" (Gui & Koropeckyj-Cox, 2016, p. 257). The
younger generations now bear the heaviest portion of the
eldercare burden all on their own.
The obstacles of providing eldercare differ across the country,
as internal population migration has shifted the countries
demographic topography. The greatest impact on eldercare
provision has been in rural areas where massive migration
towards cities by the younger population seeking economic
opportunities has led to a significantly higher proportion of
elderly residents in villages and towns without traditional care
or support (Glass, Gao & Luo, 2013). Nie estimated that over
200 million young adults have migrated from rural areas into
the cities, with that number possibly growing to reach 400
million by 2025 (2016). Numbers show that internal migration
within China is distinctly delineated by age. Chen, Xu, Li, and
Song (2018) reported that 65% of the 221 million migrant
population in 2010 were between the ages of 20 and 49 and that
nearly half of this "floating population" was between the ages
of 20 and 29. This phenomenon, they said, has not only
radically skewed the country's regional demographics but also
increased the aging levels in rural cities and escalated the rate
of aging as well (Chen et al., 2018). This departure from both
hometowns and tradition illustrates how China's antiquated
notion of filial piety is no longer sufficient to ensure that the
elderly live happy, healthy lives. The growing distance between
traditional care and reality has had as much as an impact as the
physical distances between grown children and their parents on
the lives of China's aging population.
Research shows that the erosion of traditional familial eldercare
has had several worrying impacts, mainly increased rates of
mental health issues as well as financial hardships. Loneliness
and depression are endemic to China's aging population with
over half of those above the age of 65 showing signs of deep
depression, and those affected have a scarce few options (Nie,
2016). Nie's research revealed what he called an "epidemic of
elder suicide, especially in rural areas", finding that 44% of all

4. suicides in China were elders over the age of 65. Disturbingly,
he wrote, rural elderly are three to five times more likely to
commit suicide, with rural males ten or even twenty times more
likely than their urban counterparts (Nie, 2016). In addition to
the psychological impacts, China's elderly must also contend
with financial difficulties. Very few elderly people in China
have stable incomes, with most relying on support from family
members. However, the costs of medical and elderly care, as
well as funeral arrangements, have increased significantly, even
as family sizes shrink drastically (Song, 2014). Song pointed
out that the government's pension system is not available to all
regions of the country, and only 24% of the aging population
qualified for a pension in 2010 across the entire country (2014).
Additionally, the pension system first benefits civil servants
and state enterprise employees, followed by urban residents
(Nie, 2016). Finally, the massive internal migration in China
has exacerbated the regional imbalance of pension funds (Chen,
Xu, Li, & Song, 2018), with pensions in rural areas nearly 40
times lower than that of a non-state employee in Beijing (Nie,
2016). Although mental health and financial issues are found in
almost any elderly population worldwide, China's antiquated
approach to eldercare has exacerbated these problems.
Elderly parents who have lost their only child due to accidents,
diseases, or disasters and who are unable to have a second child
face exponentially greater hardship. Song’s (2014) research
showed that these families, often called shidu families,
numbered over 1 million as of 2014, and Nie (2016) indicated
that this figure could increase by about 76,000 families each
year. Although some of these families had no choice but to have
only one child, Nie pointed out that many families willingly
supported the one-child policy. Now, he argued, these families
are forced to bear the painful consequences of elderly life with
no children to help them (Nie, 2016). Song (2014) illustrated
how some of the financial difficulties that shidu families face
have compounded, and Shidu families whose children died from
diseases are often in severe debt, having spent their life savings

5. trying to save the child. Song also wrote that common life
events for elderly people are restricted for shidu families, such
as applying to senior care homes which requires a child’s
sponsorship regardless of who pays the fees. Likewise, children
must authorize all common medical procedures and treatments
for their parents in China (Song, 2014). More than half of shidu
parents suffer from chronic illnesses, and 60% suffer from
depression, with almost the same amount showing suicidal
tendencies (Nie, 2016). Apart from elderly suicide, the plights
of shidu families are certainly one of the most critical crises in
eldercare in China.
As the traditional notion of familial eldercare is no longer
feasible, China’s elderly population now turns to non-traditional
means of long-term care. The willingness by younger
generations to care for their aging parents aside, some elderly
couples have accepted that their children are unable to meet
their needs and are now looking into non-traditional options
(Gui & Koropeckyj-Cox, 2016). Nursing homes have
historically been looked down upon, often seen as a last resort
for the most desperate. Those who do choose nursing homes as a
long-term care option, Lu, Liu, and Piggott found, discover that
the industry rations eligibility by need and there are long
waiting lists for anyone who applies. However, Lu et al.’s
research also revealed that there are as many as 2.3 million
empty beds in government-run nursing homes in urban areas
which suggests a mismatch between demand and supply,
possibly influenced by long-standing prejudices (2015). It
seems that even though there are nursing homes available to at
least some of China's population, longstanding fear and
prejudices have stopped many from utilizing them.
There are many ways the Chinese government could tackle the
countries aging problem, either by increasing local support or
by widespread policy reform. Lu, Liu and Piggott called for
increased support and promotion of nursing homes in China, as
a way to alleviate long-standing prejudice towards them (2015).
Other researchers argued that China needs to solve the problem

6. at a higher level, mainly by finding a way to balance the
economic gap between rural and urban areas which would stem
the tide of internal migrants (Chen, Xu, Li, & Song, 2018). Lu
et al. (2015) also articulated that no matter how China reforms
their eldercare related policies, they should not attempt a
system that ignores informal care. Their findings differed from
most researchers because they argued that, while lacking in
some areas, there was enough informal long-term care provision
to help most of the elderly in the country. They noted that
wherever long-term care policy structure existed, they only
targeted families who had one child or whose child had died.
Central policy guidelines, they wrote, have been "informed by
perceptions of informal care scarcity driven by the one-child
policy" (Lu et al., 2015 p. 29). Finally, Lu et al. warned that
should China's reformed policy only focus on families with one
child, many millions in rural areas who were allowed multiple
children would be left out (2015).
Many scholars recognize that eldercare should be provided at
the national level, rather than a burden placed on the individual.
Nie argued that “Eldercare is an arduous challenge not just for
these single-child families, but for the entire country” (2016, p.
353). Gui and Koropeckyj-Cox also spoke out against putting
the burden of eldercare entirely on the family, saying that “it is
not really realistic to expect these young people to solve their
family problems by themselves, nor is it fair to expect
individuals to solely shoulder the consequences of national
population policies and demographic changes” (2016, p. 270). It
is painfully clear that China’s eldercare related policies and
programs must undergo significant reform, else there will be no
better future for China’s aging population.
As China continues to pursue a brighter future for its
population, it cannot make the mistake of allowing its elderly
population to suffer any more than it already has. It is time for
the Chinese government to admit its failures in the wake of the
one-child policy and strive to reform its plan of action. No
longer can the burden of eldercare be left on individual families

7. or strangled support systems, no longer can the people rely on
antiquated notions of filial piety for care. China's elderly
population now faces depression, suicide, impoverishment, and
have nowhere to turn. Only a dramatic shift in China’s policy
and cultural ideology can save the elderly population from
living out their days alone and in pain.
References
Chen, R., Xu, P., Li, F., Song, P. (2018). Internal migration and
regional differences of population aging: An empirical study of
287 cities in China. BioScience Trends, 12(2), 132-141. doi:
10.5582/bst.2017.01246
Glass, A. P., Gao, Y., Luo, J. (2013). China: Facing a long-term
care challenge on an unprecedented scale. Global Public Health,
8(6), 725-738. doi: 10.1080/17441692.2013. 782060
Gui, T., Koropeckyj-Cox, T. (2016). “I am the only child of my
parents:” Perspectives on future elder care of parents among
Chinese only-children living overseas. Journal of Cross-Cultural
Gerontology, 31(3), 255-275. doi: 10.1007/s10823-016-9295-z
Lu, B., Liu, X., Piggott, J. (2015). Informal long-term care in
China and population aging: Evidence and policy implications.
Population Review, 54(2), 28-41. Retrieved from: https://muse-
jhu-edu.ezproxy.umuc.edu/article/591657
Nie, J. (2016). Erosion of eldercare in China: A socio-ethical
inquiry in aging, elderly suicide and the government's
responsibilities in the context of the one-child policy. Aging
International, 41(4), 350-365. doi: 10.1007/s12126-016-9261-7
Song, Y. (2014). Losing an only child: The one-child policy and
elderly care in China. Reproductive Health Matters, 22(43),
113-124. doi: 10.1016/S0968-8080(14)43755-8
GROWING OLD UNDER THE ONE-CHILD POLICY
Running Head: GROWING OLD UNDER THE ONE CHILD
POLICY

8. Growing Old Under the One-Child Policy: Current Challenges
and the Growing Need for Reform
Student, Name
University of Maryland University College
Since China enacted its draconian one-child policy nearly 40
years ago, the country has effectively curbed its explosive
population growth, and simultaneously clawed its way into
being the world’s second largest economy. However, in contrast
to its benefits, the one-child policy has also caused a number of
serious complications in China’s modern society, namely a
gender imbalance, a labor shortage, and, most importantly, a
significantly accelerated aging society. As China pours almost
all of its planning and resources into its future, the country has
all but forgotten about the people who built it in the first place.
Research into the effects of the one-child policy has typically
focused on the younger or future generations of China. But now,
more than ever, the challenges faced by China’s aging
population are at the forefront. The disparity between
traditional eldercare and today’s reality under the one-child
policy, along with the severe impacts of inadequate care, clearly
illustrates China’s responsibility to reform its eldercare
policies.
China’s one-child policy has radically impacted the country’s
demographic, which, when combined with massive internal
migration, has left millions of aging Chinese without care or
support. As noted by Zhang and Goza (2006), the combination
of lower mortality rates, increased life expectancy, and below-
replacement fertility has accelerated China’s aging society,
heralding new challenges in eldercare for the country. Eldercare
has traditionally fallen onto the shoulders of younger
generations, with parents and grandparents expecting to be

9. cared for by their grown-up children. However, the demographic
shifts under the one-child policy has strained the younger
generations ability to provide ample care and support. Gui and
Koropeckyj-Cox found that many of China’s youth felt as
though their identities as only children placed them in a unique
position to be the sole provider and caregiver, but struggle with
the reality of providing that care. They wrote, “the conflict
between work and family roles has become a major source of
concern in their lives and has contributed to eroding traditional
family arrangements” (2016, p. 257). The younger generations
now bear the heaviest portion of the eldercare burden all on
their own.
The weight of providing eldercare differs across the country, as
internal population migration has shifted the countries
demographic topography. The greatest impact on eldercare
provision has been in rural areas where massive migration into
the cities by young Chinese seeking economic opportunities has
led to a significantly higher proportion of elderly residents in
villages and towns without traditional care or support (Zhang &
Goza 2006). Nie estimates that over 200 million young adults
have migrated from rural areas into the cities, with that number
possibly growing to reach 400 million by 2025 (2016). This
departure from both hometowns and tradition illustrates how
China’s antiquated notion of filial piety is no longer sufficient
to ensure that the elderly live happy, healthy lives. The growing
distance between traditional care and reality has had as much as
an impact as the physical distances between grown children and
their parents on the lives of China’s aging population.
Research shows that the erosion of traditional familial eldercare
has had several worrying impacts, mainly increased rates of
mental health issues as well as financial hardships. Loneliness
and depression are endemic to China’s aging population, and
those affected have a scarce few options. Nie’s research
revealed what he called an “epidemic of elder suicide,
especially in rural areas”, finding that the 44% of all suicides in
China were elders over the age of 65. Disturbingly, he writes,

10. rural elderly are three to five times more likely to commit
suicide, with rural males ten or even twenty times more likely
than their urban counterparts (2016). In addition to the
psychological impacts, China’s elderly must also contend with
financial difficulties. Song reveals that very few elderly people
in China have stable incomes, with most relying on support
from family members. However, the costs of medical and
elderly care, as well as funeral arrangements, have increased
significantly, even as family sizes shrink drastically. Song
points out that government’s pension system is not available to
all regions of the country, and only 24% of the aging population
qualified for a pension in 2010 across the entire country (2014).
Additionally, the pension system first benefits civil servants
and state enterprise employees, followed by urban residents.
Pension in rural areas is nearly 40 times lower than that of a
non-state employee in Beijing, if they are allowed any pension
at all (Nie 2016). Although mental health and financial issues
are found in almost any elderly population worldwide, China’s
antiquated approach to eldercare has exacerbated these
problems.
Elderly parents who have lost their only child due to accidents,
diseases, or disasters and who are unable to have a second child
face exponentially greater hardship. Song’s research shows that
these families, often called shidu families, number over 1
million as of 2014, and Nie indicates that the number could
increase by about 76,000 families each year. Although some of
these families had no choice but to have only one child, Nie
points out that many families willingly supported the one-child
policy. Now, he argues, these families are forced to bear the
painful consequences of elderly life with no children to help
them (2016). Shidu mothers were often forced to have abortions
under the one-child policy, to which Song wrote that “all were
regretful of this fact, given the loss of their only children, but
they did not really have any other choice at the time, as the one-
child policy was rigidly implemented” (p. 120). Song also
illustrated how some of the financial difficulties that shidu

11. families face have compounded, as they cannot rely on their
children for support and many do not have siblings to rely on.
Shidu families whose children died from disease are often in
severe debt, having spent their life savings trying to save the
child. Song also writes that common life events for elderly
people are restricted for shidu families, such as applying to
senior care homes which requires a child’s sponsorship
regardless of who pays the fees. Likewise, children must
authorize all common medical procedures and treatments for
their parents in China (Song 2014). Nie adds that more than half
of shidu parents suffer from chronic illnesses, and 60% suffer
from depression, with almost the same amount show suicidal
tendencies (2016). Apart from elderly suicide, the plights of
shidu families are certainly one of the most critical crises in
eldercare in China.
As the traditional notion of familial eldercare is no longer
feasible, the Chinese government must re-evaluate their
eldercare related policies and plans. Willingness by younger
generations to care for their aging parents aside, some elderly
couples have accepted that their children are unable to meet
their needs and are now looking into non-traditional care
options (Zhang & Goza 2016; Gui & Koropeckyj-Cox 2016).
Nursing homes have historically been looked down upon, often
seen as a last resort for the most desperate, but Zhang and Goza
argue that promotion by the Chinese government could change
these opinions and alleviate many of the population’s fears.
They also recommended to replicate city neighborhood
committee programs that had found success in several urban
areas and implement the model in more rural areas. These
programs utilize community volunteers to provide support and
communal care to groups of elderly living alone (Zhang & Goza
2016). Many scholars recognize that eldercare should be
provided at the national level, rather than a burden placed on
the individual. Nie argued that, “Eldercare is an arduous
challenge not just for these single-child families, but for the
entire country” (2016, p. 353). Gui and Koropeckyj-Cox also

12. spoke out against putting the burden of eldercare entirely on the
family, saying that “it is not really realistic to expect these
young people to solve their family problems by themselves, nor
is it fair to expect individuals to solely shoulder the
consequences of national population policies and demographic
changes” (2016, p. 270). It is painfully clear that China’s
eldercare related policies and programs must undergo
significant reform, else there will be no better future for
China’s aging population.
As China continues to pursue a brighter future for its
population, it cannot make the mistake of allowing its elderly
population to suffer any more than it already has. It is time for
the Chinese government to admit its failures in the wake of the
one-child policy and strive to reform its plan of action. No
longer can the burden of eldercare be left on individual families
or strangled support systems, no longer can the people rely on
antiquated notions of filial piety for care. China’s elderly now
face depression, suicide, impoverishment, and have no where to
turn. Only a dramatic shift in China’s policy and cultural
ideology can save the elderly population from living out their
days alone and in pain.
References
Gui, T., Koropeckyj-Cox, T. (2016). “I am the only child of my
parents:” Perspectives on future elder care of parents among
Chinese only-children living overseas. Journal of Cross-Cultural
Gerontology, 31(3), 255-275. doi: 10.1007/s10823-016-9295-z
Nie, J. (2016). Erosion of eldercare in China: A socio-ethical
inquiry in aging, elderly suicide and the government's
responsibilities in the context of the one-child policy. Aging
International, 41(4), 350-365. doi: 10.1007/s12126-016-9261-7
Song, Y. (2014). Losing an only child: The one-child policy and
elderly care in China. Reproductive Health Matters, 22(43),
113-124. doi: 10.1016/S0968-8080(14)43755-8
Zhang, Y., Goza, F. (2006). Who will care for the elderly in

13. China? A review of the problems caused by China’s one-child
policy and their potential solutions. Journal of Aging Studies,
20(2), 151-164. doi: 10.1016/j.jaging.2005.07.002
GROWING OLD UNDER THE ONE-CHILD POLICY
Running Head: GROWING OLD UNDER THE ONE CHILD
POLICY