The end of a tax break for condoms in China sparks health alarms

China will soon start collecting a value-added tax on contraceptive drugs and products for the first time in over three decades, a move aligned with Beijing’s effort to get families to have more children after decades of limiting most to one child.

“Contraceptive drugs and products” will not be tax-exempt as of Jan. 1, according to the country’s newest value-added tax law. Products such as condoms will be subject to the usual 13% value-added tax imposed on most products.

While state-run news outlets have not widely highlighted the change, it has been trending on Chinese social media, drawing ridicule among people who joked they’d have to be fools not to know that raising a child is more expensive than using condoms, even if they are taxed.

More seriously, experts are raising concerns over potential increases in unplanned pregnancies and sexually transmitted diseases due to higher costs for contraceptives. The ruling Communist Party’s past “one-child” policy was enforced from about 1980 until 2015 with huge fines and other penalties and sometimes with forced abortions. In some cases, children born over the limit were deprived of an identification number, effectively making them non-citizens.

The government raised the birth limit to two children in 2015. As China’s population began to peak and then fallit was lifted to three children in 2021. Contraception has been actively encouraged and easily accessed, even for free.

“That’s a really ruthless move,” said Hu Lingling, mother of a 5-year-old who said she is determined not to have another child. She said she would “lead the way in abstinence” as a rebel.

“It is also hilarious, especially compared to forced abortions during the family planning era,” she said.

In 2024, 9.5 million babies were born in China, about one-third fewer than the 14.7 million born in 2019, according to the National Bureau of Statistics. That’s despite a higher-than-usual birth rate driven by a traditional preference to give birth in the Year of the Dragon, according to Chinese astrology.

As deaths have outpaced births in China, India overtook it as the world’s most populous country in 2023.

The effect of the tax “on encouraging higher fertility will be very limited. For couples who do not want children or do not want additional children, a 13% tax on contraceptives is unlikely to influence their reproductive decisions, especially when weighed against the far higher costs of raising a child,” said Qian Cai, director of the Demographics Research Group at the University of Virginia.

Still, imposing the tax is “only logical,” said Yi Fuxian, a senior scientist at the University of Wisconsin-Madison.

“They used to control the population, but now they are encouraging people to have more babies; it is a return to normal methods to make these products ordinary commodities,” Yi said.

As is true in most places, most responsibility for birth control in China falls to women. Condoms are used by only 9% of couples, with 44.2% using intrauterine devices and 30.5% female sterilization, followed by 4.7% male sterilization, according to research released by Bill & Melinda Gates Foundation in 2022. The rest use the pill or other methods.

Given the authorities’ longstanding invasive approach to their personal lives and bodies, some women are offended by the authorities’ effort to again influence their personal choices about childbearing.

“It is a disciplinary tactic, a management of women’s bodies and my sexual desire,” said Zou Xuan, a 32-year-old teacher in Pingxiang in China’s southern province of Jiangxi.

There is no official data on the scale of China’s annual condom consumption and estimates vary. A report released by IndexBox, an international market intelligence platform, said China consumed 5.4 billion units of condoms in 2020, marking the 11th straight year of increase.

Experts have expressed worries that reduced condom use could add to public health risks.

“Higher prices may reduce access to contraceptives among economically disadvantaged populations, potentially leading to increases in unintended pregnancies and sexually transmitted infections. Those outcomes could, in turn, lead to more abortions and higher health-care costs,” said Cai, the director.

China has one of the world’s highest numbers of abortions, with 9 million to 10 million annually in 2014-2021, according to its National Health Commission. Experts say the actual number could be higher, with some seeking treatment at underground clinics. China stopped publishing its abortion data in 2022.

Sexually transmitted infections have also been rising, despite a decrease during the COVID-19 pandemic years, with over 100,000 gonorrhea patients and 670,000 syphilis patients in 2024, according to data from the National Disease Control and Prevention Administration.

The number of patients living with AIDS and HIV infections has also been rising, especially among older Chinese, reaching about 1.4 million in 2024.