Losing Asia’s young generation: A quiet crisis in the making
Vietnam ends 2-child policy
It’s over.
Vietnam abolished its long-running two-child policy in June 2025 after decades of strict enforcement, especially among Communist Party members. Originally introduced to curb rapid population growth, the policy succeeded in bringing fertility rates down from over four children per woman to below replacement level. But with birth rates dropping to 1.91 in 2024 and the population aging, the government is now reallocating healthcare resources to support families and boost fertility.
The healthcare system is adjusting to expected increases in demand for prenatal, delivery, and pediatric services. New policies include extended maternity leave, expanded access to maternal care and infertility services, and incentives for earlier childbearing. Authorities are also investing in local healthcare infrastructure and offering targeted support in low-fertility areas. While the shift aims to stabilize population growth, high child-rearing costs and urban fertility declines remain challenges, requiring ongoing health system adaptation and regional strategies.
Vietnam’s experience reflects a broader regional trend. Many countries in Asia face similar demographic shifts that affect not only population size but also economic and social structures.
East Asia averts a shrinking, aging population
Several countries in East Asia are confronting a growing demographic crisis marked by falling birthrates and shrinking young populations. Fertility rates have dropped well below the replacement level of 2.1 children per woman, according to data from the United Nations (UN) 2024 World Population Prospects, and governments are struggling to reverse this trend.
For example, South Korea reports the world’s lowest fertility rate at 0.72 births per woman in 2023, with projections suggesting it may fall further to 0.68 by 2024. The country has declared a demographic emergency amid fears that its population could halve by the end of the century. Similarly, Japan’s fertility rate stands at 1.15, with fewer than 690,000 births reported in 2024. School closures and a median age of nearly 50 underscore the growing social and economic impacts.
China, despite scrapping its one-child policy, still faces declining births. The population dropped by over 2 million in 2023. Even after allowing up to three children per family, the fertility rate remains around 1.7, while the working-age population shrinks. Taiwan’s fertility rate has fallen dramatically from 7 in the 1950s to 0.87 in 2022, with over 41% of its population expected to be over 65 by 2060. Hong Kong’s fertility rate is about 0.7, and its elderly population could reach 40% by 2050. Singapore recorded a fertility rate of 0.97 in 2023. While immigration has helped stabilize its population, low birthrates continue to raise concerns about workforce replacement and eldercare.
Underlying these declines are economic pressures such as high living costs and job insecurity, alongside cultural factors including gender inequality and changing social norms. Delayed marriage, declining interest in childbearing, and shifting lifestyle choices further contribute to the trend.
Governments have responded with cash incentives, improved parental leave, and childcare support, but these measures have had limited impact due to deeper structural and cultural challenges.
Shifting away from two-child rule in Asia
In response to these demographic realities, several governments that once promoted or enforced two-child limits have shifted course, moving away from birth control restrictions toward policies that encourage larger families.
China’s policy evolution illustrates this shift. After replacing its one-child policy with a two-child limit in 2016 to slow population decline, the initial rise in births was short-lived due to economic pressures and urban lifestyles. In 2021, all birth limits and penalties were lifted, allowing couples to have as many children as they choose. While projections suggested potential workforce growth by 2040 and 2050, the population continued shrinking, and aging persisted.
Historically, British Hong Kong promoted a two-child ideal through public campaigns such as “Two is Enough” during the 1970s, without legal enforcement. This helped reduce birthrates amid rapid urban growth. Today, there are no family size restrictions, and the government supports families with multiple children.
Myanmar’s targeted two-child limit applied specifically to the Rohingya Muslim minority sparked international condemnation for human rights abuses and failed to address demographic issues, instead worsening social tensions.
Singapore’s earlier “Stop at Two” campaign in the 1970s and 1980s contributed to a sharp birthrate decline during rapid development. Later, when fertility fell below replacement level, Singapore reversed course and introduced incentives to encourage larger families.
Rechanneling options and impact on healthcare systems
These policy shifts have significant consequences for healthcare systems across Asia, which now face the dual pressures of aging populations and changing fertility patterns. The legacy of two-child policies has intensified existing healthcare challenges, with some systems struggling to adapt to rapid demographic change.
In China, replacing the one-child policy with a two-child limit reduced forced abortions and unregistered children, improving access to maternal and child health services. However, the resulting birth surge strained pediatric care and revealed shortages in healthcare staff, especially in rural areas. Singapore’s voluntary “Stop at Two” campaign lowered birthrates and eased demand for maternal services, but the need to counter fertility decline later prompted policy and health system adjustments. British Hong Kong’s educational approach eased pressure on health services without coercion, allowing gradual adaptation. In contrast, Myanmar’s targeted two-child restriction on the Rohingya worsened reproductive health outcomes and denied access to care, triggering a humanitarian crisis.
Across the region, governments must now realign healthcare priorities to support family growth while managing the demands of aging populations. China has redirected resources from strict birth control enforcement toward maternal and child health services and elderly care, retraining former family planning workers and expanding pediatric capacity. Singapore has increased investments in public hospitals, maternity support, and elder care as it shifted focus from discouraging births to promoting family growth. British Hong Kong, following the end of its population campaigns, redirected funds into inclusive healthcare and welfare programs without fertility restrictions. In Myanmar, the fallout from the Rohingya two-child policy and refugee crisis has strained health resources, requiring emergency care, outbreak control, and refugee health services.
At the end of the day, policies that impact populations require the foresight of governments. How they respond to demographic changes will influence not only future population trends but also the resilience and equity of their healthcare systems.
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