Taiwan needs more babies. But conservative traditions are holding back some fertility solutions

By Eric Cheung, CNN

Taipei, Taiwan (CNN) — For married Taiwanese men Alan Hung and Danny Huang, the process of having a biological child together was never easy.

The couple dreamed of starting a family soon after tying the knot in 2019, around the time Taiwan became the first Asian jurisdiction to legalize same-sex marriage.

“Many of our friends already had their own children, and we also hoped we could show our parental love,” Huang said.

But gay men are not allowed to access artificial reproduction tools in Taiwan, so the couple – both university professors in their mid-40s – had to look abroad.

First, they spent more than a week at a fertility clinic in Russia, only to find out the procedure couldn’t be completed due to regulatory changes. Later, they found success with a surrogate in the United States – but with a hefty cost in excess of $160,000.

Cases like this are troubling to Chen Ching-hui, who last month became the first fertility specialist to win a seat in Taiwan’s parliament.

“Taiwan’s medical technology is well ahead of many other countries, so why are we making people spend large sums of money to travel overseas?” she said in an interview with CNN.

Same-sex couples and single women are banned from accessing procedures such as in vitro fertilization (IVF) or egg freezing in Taiwan, while surrogacy is outlawed entirely.

Now, Chen and others are pushing for a loosening of restrictions, in the face of a shrinking population that threatens not only the economy but also the island’s ability to defend itself against an increasingly assertive China.

While declining fertility is a problem for developed economies across East Asia, the problem is especially acute for the democratically governed island of 24 million people.

It has one of the lowest birth rates in the world, and the number of newborn babies is declining every year. In 2022, its total fertility rate – the number of births from a woman in her lifetime – was just 0.87, significantly lower than Japan (1.26) and Singapore (1.05), and only slightly higher than South Korea (0.78).

A birth rate of 2.1 is needed to maintain a stable population, in the absence of immigration.

Other governments in the region have tried cash reward programs to encourage parents to give birth. In Hong Kong, parents receive US$2,550 for each newborn baby, while in South Korea, the subsidy ranges from $1,500 for the first baby, to $2,260 to the second or more. In Japan, the government announced last year that it will double the budget for childcare spending.

Boosting the birth rate

Addressing what she called the “burning problem” of population decline in Taiwan, Chen said one of her top priorities as a lawmaker will be to lead efforts to widen access to assisted reproduction.

The renowned doctor, representing the opposition Kuomintang (KMT) – a traditionally more conservative party – said her proposal will prioritize IVF access for single women, lesbian couples, and unmarried heterosexual couples, which she believed would be less controversial than surrogacy to Taiwanese society.

“On the topic of surrogacy, it is important to continue discussions in our society,” she said. “I really hope that this can be passed in my (four-year) term.”

Chen said about 17% of the 135,571 births in Taiwan in 2023 were from assisted reproduction, adding that if the rules are further relaxed, Taiwan could expect a rise in the birth rate of 20% to 30%.

The issue is particularly pressing for Taiwan because, as its population dwindles, so do its military ranks.

Its professional military force had 155,000 members in June 2023, according to a parliamentary report, a substantial decline from 165,000 just two years ago and the lowest figure since 2018.

And that’s bad news at a time when Taiwan is trying to bolster its forces to deter any military move by China, where the ruling Communist Party considers the island democracy as a part of its territory and vows to “unify” it by force if necessary – despite having never controlled it.

Some analysts believe the declining birth rate poses a bigger threat to Taiwan than to other regional economies such as Japan or South Korea, because Taiwan’s population base is much smaller, and it lacks concrete security assurances from other countries in the event of military conflict.

Taiwan’s Institute for National Defense and Security Research has called the population decline a “national security issue.”

Taiwan’s democracy, much like the United States, has historically been dominated by two major parties who rarely see eye to eye, but the island’s falling population is a rare issue of bipartisan consensus.

The ruling Democratic Progressive Party agrees on the need for action.

In January, health minister Hsueh Jui-yuan said amending reproductive rules was a priority, and his ministry is also set to hold public hearings in the next two months on how existing regulations should be loosened.

Besides the military, the decline in Taiwan’s working population also threatens the long-term performance of the island’s economy. Currently the world’s 21st-largest economy, it is an undisputed leader in the supply of semiconductor chips, which play an indispensable role in everything from smartphones to computers.

But it faces a growing labor shortage, and is increasingly reliant on migrant workers from Southeast Asia to fill positions across many industries such as manufacturing, construction and agriculture.

Toward full equality

Chang Hsun-ming, director of the gynecology department at China Medical University Hospital, which is based in Taiwan, said “it makes sense to have a gradual loosening of restrictions” around reproduction.

“We are fully capable of handling these procedures with our existing technology,” said Chang, who has more than three decades of experience in this field.

Chen, the new lawmaker, agreed, but she admitted there was one area where Taiwan perhaps still doesn’t have a clear consensus: the legalization of surrogacy.

As discussions about relaxing assisted reproduction tools gained momentum in Taiwan, opposition groups have held press conferences and called for the legislative amendments to be postponed, citing concerns about the welfare of children born into “incomplete families.”

Some also expressed worries that surrogacy could “lead to the commercialization of the uterus” – a claim Chen believed could be mitigated through enacting a comprehensive legal framework that protects the rights of surrogate mothers during pregnancy.

The likely exclusion of surrogacy in the first round of discussions means that gay couples like Hung and Huang – whose baby boy, Aiden, just turned nine months old – will continue to be prevented from accessing assisted reproduction technologies in Taiwan, at least for the time being.

Since the legalization of same-sex marriage in 2019, Taiwan has gradually granted full recognition to same-sex transnational marriages and equal adoption rights, leaving access to assisted reproduction the final hurdle toward full marriage equality.

“I think that any couple who put real effort into starting a family – regardless of whether they are straight or gay – are equally excited in welcoming a new member to the family, and they share identical love to their children,” Huang said.

“We hope with ample discussions, the new law will afford equal treatment to every person who wishes to start a family.”

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