Short abstract:

This paper explicates how and why the national demographic anxiety and the pronatalist call propagated by the state are rarely translated into IVF doctors’ clinical reasoning and practices in China even though medical professionals are often the active agents of the state’s reproductive governance.

Long abstract:

In 2016, China replaced its 36-year-long One Child Policy with a universal Two-Child Policy, which was soon substituted by the Three-Child Policy in 2021. The close interweaving between the state’s population and reproductive governance and Chinese medical institutions often renders the health professionals, as or being viewed as the active agents of biopolitical governance. However, my 23 months of fieldwork in two top-ranking IVF clinics between 2017 and 2023 reveals that even doctors’ seemingly accordant discourses and practices oftentimes do not parallel the government’s goals. Invoking medical and ethical concerns rather than their role as policy implementers, IVF doctors position themselves as professionals holding biomedical authority. Whereas the new population policies have transferred the responsibilities and expectations of reproduction from medical institutions to families, doctors rather than the patients often serve as “moral pioneers” to cut off these transfers of reproductive responsibility through their medical authorities. On the one hand, this stance leads to doctors’ emphasis on women’s “advanced maternal age” and low success rates due to female infertility, which unwittingly helps reinscribe the state’s disparagement of declining fertility rates caused by women. On the other hand, IVF doctors’ advice and practices coincidentally side with the women’s reproductive autonomy which conflicts with their family members’ desire and the state’s call for multi-child families. The state sentimentalizes the demography anxiety and defines reproduction biomedically and demographically, which nevertheless is reframed and reenacted by IVF doctors, supplemented by their ethical definitions of well-being and moral reasonings about an ideal family.