Call for new approach to end silence over miscarriage

By Katie Hunt, CNN 4/27/2021

Miscarriages are common. Some 23 million pregnancies worldwide end in miscarriage every year -- that's 15% of all pregnancies or 44 each minute, according to new estimates published in The Lancet medical journal on Monday.

© Getty Images A new system that provides women suffering miscarriage with physical and mental health support is needed, found new research published in The Lancet medical journal.

However, existing care and support for women and couples is "inconsistent and poorly organized" and amounts to little more than patients being told to "just try again," said the authors of three new studies on the causes, treatment and scale of miscarriage around the world. A new system is needed to ensure miscarriages are better recognized by health care practitioners and women are given the physical and mental health support they need, the researchers said.

"Many womn have concerns over the unsympathetic care they receive following a miscarriage -- with some not being offered any explanation, and the only advice they receive being to try again. This is not good enough, and we must ensure women are properly supported," Siobhan Quenby, a professor of obstetrics at the University of Warwick in the United Kingdom, said in a news statement. Quenby is also deputy director of Tommy's National Centre for Miscarriage Research and was one of 31 experts who authored the three studies.

The actual number of cases is likely "considerably higher," as many miscarriages are managed at home and go unreported or they are undetected. However, the research said recurrent miscarriages are much less common, with 2% of women having experienced two miscarriages and less than 1% of women having three or more, according to a review of published scientific literature.

While definitions of miscarriage vary, it's generally defined as the loss of a pregnancy before viability, the authors said.

Misconceptions about pregnancy loss

Miscarriage is often misunderstood by women, men and health care professionals -- and misconceptions persist.

For example, the authors said, women might believe it's rare -- when it affects one in 10 women across their lifetime -- that there are no effective treatments, and that it could be caused by lifting heavy objects or previous contraceptive use. These misconceptions often prevent women from seeking help.

And when women do seek help, they often need to attend many clinics to find a cause for miscarriage, and there is rarely one place that can address all their needs, according to the research. Patients are often treated by multiple practitioners, who frequently give conflicting advice. This can add to women's distress as they process the loss.

An editorial published by The Lancet alongside the research said that for too long, miscarriage had been "minimized and often dismissed."

"The lack of medical progress should be shocking. Instead, there is a pervasive acceptance," the editorial said.

Recently, celebrities like Meghan, Duchess of Sussex, and Chrissy Teigen have helped chip away at the long-standing culture of silence around miscarriage and baby loss by sharing their own stories.

"Miscarriage causes devastation to large numbers of couples in every country; there is silence around miscarriage from women and their partners, health-care providers, policy makers, and funders," the researchers said.

Given the fragmented system that exists in most countries, the authors proposed a new system of miscarriage care and treatment that they said governments and health care providers should make universally available:

After a first miscarriage, women should have their physical and mental health needs evaluated and be provided with guidance to support future pregnancies.

If a second miscarriage occurs, women should be offered an appointment at a dedicated miscarriage clinic for full blood count and thyroid function tests, as well as a discussion of their risk factors. Women who have had two miscarriages and then get pregnant should be offered extra support and early scans for reassurance.

After three miscarriages, additional tests and treatments should be offered including genetic testing of pregnancy tissue, as well as pelvic ultrasound and, if necessary, parental genetic testing.

Study coauthor Chandrika N. Wijeyaratne, a senior professor of reproductive medicine at the University of Colombo in Sri Lanka, said in a statement that there needs to be a minimum service available globally for women who have had recurrent miscarriages.

"Women -- and sometimes their partners -- who do not have children face discrimination, stigma, and ostracism in many cultures worldwide, but miscarriage prevention remains a low public health priority in many low- and middle-income countries, where there are many competing health care priorities and services for women can be especially limited."


Miscarriage risk factors

The new research highlighted several factors that have been linked with a higher risk of miscarriage.

These include increasing age for both men and women and having a very low or high body mass index. Ethnicity may play a role as well: Black parents were more likely to experience pregnancy loss when compared to White couples. Smoking, drinking alcohol, persistent stress, working night shifts, and exposure to air pollution and pesticides have also been associated with an increased risk in miscarriage.

While there is limited evidence, some treatments including progesterone, a hormone essential to a healthy pregnancy, could help women who experience miscarriages, the research said. However, much more research is needed, including new clinical trials and dedicated research centers with expertise in genetics, developmental and reproductive biology, and data science.

"Not all miscarriages could be avoided, but the insidious implication that miscarriage, like other women's reproductive health issues, including menstrual pain and menopause, should be managed with minimal medical intervention is ideological, not evidence based," said the editorial that accompanied the research.

This new body of research should, it added, "catalyze a major focus on miscarriage for the medical research community, for service providers, and for policy makers. The era of telling women to 'just try again' is over."

The doctor behind 'The Vagina Bible' wrote a new book on menopause, and she says she's skeptical of the startups targeting middle-aged women

pyeo@businessinsider.com (Patricia Kelly Yeo) 15 hrs ago

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© Peacock Alley Entertainment Dr. Jen Gunter in 2019. 

Gynecologist Jen Gunter's new book debunks myths about menopause.
Gunter said most startups that are trying to tackle menopause aren't selling anything new.

Her expert advice for those approaching or in menopause: quit smoking, exercise, and eat healthy.

Menopause - medically defined as the stage after a biological female's final menstrual period - is as universal an experience as first starting your period in puberty.

Accompanied by declining levels in sex hormones and eventual loss of fertility, the experience of going through menopause isn't exactly well-depicted in media or commonly spoken about - so Dr. Jen Gunter wrote her second book about it.

"Menopause is puberty in reverse," she writes in "The Menopause Manifesto," set to be published May 25. Unlike pregnancy, menopause will happen in all biological females who live past a certain age, yet few honest, accessible, and women-centered discussions on the reproductive transition exist, Gunter said.

Beyond the loss of period and measured hormonal declines, menopause symptoms can vary widely. Common ones include changes in body temperature, mood, sleep, weight, and sex drive.

Intended to be an inclusive, educational and historical guide to the fertility transition, "The Menopause Manifesto" is Gunter's follow-up to The New York Times-bestselling "The Vagina Bible" published in 2019.

Gunter, a practicing gynecologist in the Bay Area, also dispenses science-backed health advice for women across the board.

Having first spoken out against Goop's controversial jade eggs in 2017, Gunter is a vocal online critic of health misinformation and the many forms misogyny can take within it.

Speaking to Insider, Gunter said she was inspired to write "The Menopause Manifesto" largely due to the negative stereotypes women approaching menopause face around their sexual value and social worth, as well as the lack of easily understandable, de-stigmatized information on the biological transition.

Similar to her first book, it cuts through the misogyny embedded in conventional Western medicine to talk about women's health to debunk myths and provide historical and social context. Her 25 years of clinical experience and her personal experiences with premenopause, the long and varied phase leading up to it, guided its writing as well.

Gunter's focus on aging women is happening at a time when there's been a"menopause product boom," and calls for increased venture funding. Though she said that women over the age of 45 have been "treated like a silent demographic," Gunter expressed skepticism about the increased attention to the estimated $600 billion market.

"If you need calcium, you can take a calcium supplement," she said. "Why do you need one branded for menopause? Is that like a pink tax, plus a menopause tax on top of it?"

Instead, Gunter offered three general health recommendations for those either already in or approaching menopause: quit smoking, exercise, and eat a healthy diet - with plenty of fiber.
Venture-backed menopause startups aren't doing anything new

"The Menopause Manifesto" draws upon dozens of scientific studies evaluating the evidence for different approaches to managing menopause symptoms, most of which are caused by declining levels of the sex hormone estrogen.

One of the first mainstream medical treatments for menopause that might come to mind is hormone replacement therapy. In her book, Gunter rejects the term for its value-laden connotations, preferring to use the term menopausal hormone therapy, or MHT.

"While MHT can be helpful for many people, it really needs to be looked at as one part of the puzzle," Gunter said. "Often the focus seems to be on estrogen, as opposed to the whole experience."

Other approaches beyond MHT and lifestyle recommendations, Gunter found, have little evidence for wellness and alternative health products in treating the symptoms of menopause. In "The Menopause Manifesto," she devotes seven chapters to both medical treatments and unregulated products, including dietary supplements, bioidentical hormones, birth control, and MHT.

Although Gunter said she would need to consider each product on an individual basis, she's wary of slickly marketed products, particularly supplements and other combination products that market themselves as blanket solutions.

"Things claim to be 'ovary support' or 'menopause support,' but that's a medically meaningless term," she said. "Most people don't need to take a supplement."

With the exception of omega-3 fatty acids and vitamin B12, the data on efficacy for most menopause-targeted supplements, including popular multivitamins, remains spotty and scarce, according to "The Menopause Manifesto." Despite the billions of dollars consumers pour into the supplement industry, food remains the best way to get micronutrients.

In the last year, she said a handful of startups have pitched her menopause-related ventures, none of which seemed to be different for existing free resources for menopause patients.

"Someone pitched me some app that women would sign up for and pay for with all the guidelines [for menopause]," Gunter said.

"And I'm like, 'The North American Menopause Society has one and it's free! How is your app different from that?' Then there's just a big silence."
Her doctor's advice for managing menopause symptoms is science-backed and likely unsurprising

Menopause symptoms can include hot flashes and brain fog. Gunter pointed to some ways to improve health and well-being during that time.

Gunter's recommendations for people in menopause are simple: quit smoking, strive for the American Heart Association's recommended 150 minutes of weekly aerobic exercise, and learn how to eat healthier - including hitting the broadly recommended daily 25 grams of fiber.

"The science of nutritional studies is really challenging for a lot of reasons, but the takeaway really is that people need to eat more vegetables," she said.

In addition to getting enough fiber, Gunter added we'd likely all be a little bit better off with trying to eat more plant-based protein and minimizing processed food. More accessible, high fiber, healthy food would improve public health overall, and reduce people's risk of other conditions like hemorrhoids and colorectal cancer.

"I guess what people can benefit from isn't sexy," she added. "Nobody wants to buy a book about the hundred joys of fiber."

Gunter also highlighted adding weight-bearing exercise, since strength training can help mitigate the effects of bone loss and accelerated loss of muscle mass that occurs during menopause.

What works for one person may not work for another, but Gunter is firm in her belief we all probably need to move our bodies more - a message that's often lost in Instagram-friendly advertising for women's health products.

"If health and wellness is something that appeals to you - exercising and learning how to eat better and prepare meals is good, but there isn't a specific pillow or bed sheet or supplement that's going to help with menopause," she said.

 Ontario’s failed plan for paid sick leave falls flat 

REAL FAKE NEWS
NY Post Reporter Resigns, Says She Was 'Ordered to Write' False Kamala Harris Story

J. Clara Chan

THEWRAP

4/27/2021

© TheWrap New York Post Kamala Harris cover

The Post's Laura Italiano says the article about Harris' book was her "breaking point"

A New York Post reporter who wrote a since-retracted article about migrant children getting a copy of Vice President Kamala Harris' book as part of "welcome kits" said she resigned on Tuesday after she was "ordered to write" the story.

"Today I handed in my resignation to my editors at the New York Post," reporter Laura Italiano tweeted. "The Kamala Harris story — an incorrect story I was ordered to write and which I failed to push back hard enough against — was my breaking point."

Video: Right wing falls for bogus story about Kamala Harris (MSNBC)
Duration 2:40

A spokesperson for the Post, which is owned by Rupert Murdoch's News Corp., did not immediately respond to a request for comment.

Fox News Walks Back Report That Kamala Harris' Book Was Given to Migrant Kids (Video)

The story originally was published last Friday, promoted on the Post's Saturday front page and amplified by Fox News and prominent Republicans like RNC chair Ronna McDaniel and Sen. Tom Cotton. But according to fact-checking from other outlets, including The Washington Post, Harris' book, "Superheroes Are Everywhere" has not been handed out to children as part of "welcome kits" at a shelter in Long Beach, California. One single copy of the book was donated during a donation drive, Long Beach officials told The Washington Post.

On Monday, the incorrect New York Post piece was taken offline briefly before a heavily edited version was reposted with an editor's note that read, "The original version of this article said migrant kids were getting Harris' book in a welcome kit, but has been updated to note that only one known copy of the book was given to a child."

Undocumented workers in B.C. worry COVID-19 vaccine could get them deported

Duration: 02:10 

4/27/2021

Many undocumented workers in British Columbia are hesitant to get a COVID-19 vaccine over concerns that if their status is revealed at a vaccination clinic, they could be deported.

CANADA

Parliamentary report calls for ‘coercive control’ to become crime
Duration: 02:01

 cbc.ca

 4/27/2021
A parliamentary report and an aligning private member’s bill calls for "coercive control" to be added to the criminal code.

Six Nations elected chief endorses building moratorium, calls for unity with Confederacy ahead of hearing on land claims

Six Nations Elected Chief Mark Hill has signalled his support for the development moratorium within the Haldimand Tract declared by the Haudenosaunee Confederacy Chiefs Council last week.

“We reiterate and acknowledge their call for the moratorium,” Hill said, noting the elected council’s “major” land claims lawsuit against the federal government is scheduled to be heard in court late next year.

“It would not be responsible to allow continued development in an uncertain legal environment,” Hill said. “The government of Canada owes Six Nations potentially in the trillions of dollars in relation to our lands.”

Hill made the comments during a virtual press conference on Monday while discussing the importance of finding common ground with the Confederacy on issues such as clean drinking water on the reserve, new long-term and palliative-care facilities, and the need for a permanent home for Kawenni:io Language School, which has been without a fixed address for its 30-plus-year history.

The Confederacy — made up of hereditary chiefs and clan mothers — announced any developers wishing to build along the Grand River need to first go through a consultation with the Confederacy’s development arm, the Haudenosaunee Development Institute.

“In terms of the (consultation) process, we need to make sure the people are part of that process as well, and what that looks like,” Hill said.

“We need to all be held accountable for our actions, and again, be accountable to our people.”

The federal government has said the elected and hereditary leadership — often at loggerheads over who is the legitimate authority on Six Nations — must smooth over their long-standing differences before negotiations can begin over the future of 1492 Land Back Lane, a planned Caledonia housing development presently occupied by Six Nations land defenders.

“We have to develop that road map together in order to get to unity,” said Hill, who characterized recent talks between the two councils as “optimistic.”

“Our people have said over and over again that they would like to see the two bodies work together,” he said.

“What that looks like is the big question.”

The chief said one positive to come out of the pandemic was how representatives from both councils collaborated on public health measures.

“We’ve come together on this issue, and it’s that beauty of when our people do come together, we can really flourish,” he said, expressing hope the two councils can join forces “and once and for all address our long-standing land issues.”

“We have to make sure that we’re keeping Ontario and Canada accountable, because this is very much part of their issue as well,” Hill said.

J.P. Antonacci, Local Journalism Initiative Reporter, The Hamilton Spectator

CRIMINAL CAPITALI$M CHARTER SCHOOLS
Former Obama White House adviser arrested for allegedly stealing over $200,000 from charter schools he founded

By Sonia Moghe, CNN 

© C-SPAN/FILE Seth Andrew speaks about charter schools on C-SPAN in 2017

A former White House senior adviser for the Obama administration who helped found a network of charter schools is accused of allegedly stealing hundreds of thousands of dollars from the schools and attempting to launder the funds in order to get a lower interest rate on a mortgage for a Manhattan apartment, according to federal prosecutors.

Seth Andrew was charged by prosecutors in the US Attorney's Office for the Southern District of New York with wire fraud, money laundering, and making false statements to a bank.

Prosecutors say Andrew helped create a network of charter schools based in New York City in 2005, and left the network in 2013 for a job at the US Department of Education, and later became a senior adviser in the Office of Educational Technology at the White House, where he continued to be paid by the charter school network. Prosecutors say Andrew left his role in the White House in November 2016 and cut ties with the school network in January 2017.

Andrew was taken into custody Tuesday in Manhattan and released on a personal recognizance bond after an initial appearance, SDNY spokesman James Margolin said. Andrew's attorney, Michael Yaeger, said Andrew will plead not guilty and is reviewing the government's case. No plea was entered Tuesday, Margolin said.

Andrew was the founder of Democracy Prep Public Schools, a network of more than 20 public charter schools from Harlem to Washington, DC, according to an email sent to Democracy Prep families and alumni Tuesday morning that was released to CNN.

CEO Natasha Trivers said that Democracy Prep alerted the appropriate authorities once it learned about the unauthorized withdrawals.

"Seth left our network in 2013. His alleged actions are a profound betrayal of all that we stand for and to you and your children, the scholars and families that we serve," Trivers' email said. "To be clear, at no time did the alleged crimes pose any risk to our students, staff or operations in any way."

Trivers also added that the activity did not have "any adverse effect on our scholars or the functioning of our schools" and that the school system has since instituted financial safeguards, which lead to the discovery of the withdrawals.

According to a criminal complaint filed on April 20 and unsealed Tuesday, prosecutors allege that between March and August of 2019, Andrew used his former association with the network of schools to allegedly steal $218,005 of the school's reserve money by using his email address affiliated with the schools to email a bank employee and convince them that he was still associated with the school, which he was not.

The complaint states that after allegedly stealing the school network's money, Andrew "attempted to conceal the source of the stolen funds ... and make it appear that the stolen funds belonged to a non-profit organization that Andrew founded, and currently appears to control."

Prosecutors allege Andrew misrepresented that he "lawfully controlled" the money in order to obtain a discounted mortgage interest rate to buy an apartment in Manhattan.

This story has been updated with additional reporting.

Sustainable engineers Kenoteq are reinventing the brick

Rebecca Cairns, CNN 

4/27/2021


Although we're surrounded by millions of them every day, most of us don't think about bricks too often. For thousands of years, the humble clay-fired brick hasn't changed. The building blocks of modern suburban homes would be familiar to the city planners of ancient Babylon, the bricklayers of the Great Wall of China, or the builders of Moscow's Saint Basil's Cathedral.

© Kenoteq Gabriela Medero, co-founder of Kenoteq, came up with the idea for the K-Briq over a decade ago.

But the brick as we know it causes significant environmental problems, by using up raw, finite materials and creating carbon emissions. That's why Gabriela Medero, a professor of Geotechnical and Geoenvironmental Engineering at Scotland's Heriot-Watt University, decided to reinvent it.

Originally from Brazil, Medero says she was drawn to civil engineering because it gave her passion for maths and physics a practical outlet. As she became aware of the construction industry's sustainability issues, she started looking for solutions. With her university's support, Medero joined forces with fellow engineer Sam Chapman and set up Kenoteq in 2009.

The company's signature product is the K-Briq. Made from more than 90% construction waste, Medero says the K-Briq -- which does not need to be fired in a kiln -- produces less than a tenth of the carbon emissions of conventional bricks. With the company testing new machinery to start scaling up production, Medero hopes her bricks will help to build a more sustainable world.


The problem with bricks

Although they're made from natural materials, there are problems with bricks at every step of their production.

Bricks are made from clay -- a type of soil found all over the world. Clay mining strips the land's fertile topsoil, inhibiting plant growth.

In conventional brick production, the clay is shaped and baked in kilns at temperatures up to 1,250°C (2,280°F). The majority of brick kilns are heated by fossil fuels, which contribute to climate change.

Once made, bricks must be transported to construction sites, generating more carbon emissions.

Globally, 1,500 billion bricks are produced, every year. Laid end-to-end, they would stretch to the moon and back 390 times.

The environmental footprint of different bricks reflects multiple factors including the type of kiln, fuel, and transportation. But with so many produced, their impact adds up, says Medero.

Enter the K-Briq. To make it, construction and demolition waste including bricks, gravel, sand and plasterboard is crushed and mixed with water and a binder. The bricks are then pressed in customized molds. Tinted with recycled pigments, they can be made in any color.

© Chris Ratcliffe/Bloomberg/Getty Images

 A brick kiln in West Sussex, in the south of England.

Earlier this year, Kenoteq won its first commission -- to supply bricks for the Serpentine Pavilion 2020 in London's Hyde Park (although the project has been postponed until summer 2021 due to the current pandemic). Designed by architectural studio Counterspace, the building will incorporate K-Briqs in grey, black and 12 shades of pink. The Pavilion's lead architect, Sumayya Vally, says that as a recycled product, the K-Briq appealed to her. It "embodies" the past through its use of old materials, she says, adding that because the bricks can be customized, they allow "the designer to be a part of the construction process of the material," creating unique opportunities in architecture.


Why can't old bricks be re-used?

In the UK, around 2.5 billion new bricks are used in construction every year -- and about the same number of old bricks are demolished. A seemingly simple solution to the brick production problem would be to re-use old bricks.

© Jorge Guerrero/AFP/Getty Images A clay quarry in Andalusia, Spain

But it's not that straightforward. According to Bob Geldermans, a climate design and sustainability researcher at Delft University of Technology in the Netherlands, reclaiming bricks is an expensive and "labor-intensive process."

According to the UK's Brick Development Association, old brick structures need to be carefully dismantled and the bricks cleaned of mortar with hammers and chisels. Reclaimed bricks are used to help renovate historic buildings or for other specialized projects but for mass construction, the process is too costly.

An additional barrier is that there's no standardized way to check the strength, safety or durability of reclaimed bricks.

Medero says that K-Briqs could solve both these problems.

According to Medero, the K-Briq will be comparably priced to conventional bricks. Additionally, as a new product, the K-Briq has been subjected to rigorous assessment at the materials testing lab at Heriot-Watt University, and is in the process of being certified by regulators. Medero claims that K-Briqs are stronger and more durable than fired clay bricks, and provide better insulation, too.

Scaling up

Kenoteq currently operates one workshop in Edinburgh, which can produce three million K-Briqs a year. Medero is looking at scaling up -- but it's hard to create a revolution in construction.

Geldermans says that the industry is notoriously slow to change -- adding that legislation often lags far behind innovation, so construction companies are not incentivized to adopt sustainable practices and materials.

Stephen Boyle is the program manager for construction at non-profit Zero Waste Scotland which, along with organizations including Scottish Enterprise and the Royal Academy of Engineering, has provided Kenoteq with funding. He attributes the industry's conservatism to a "chicken and egg" situation. Innovative startups need large contracts to allow them to scale, he says, but struggle to become competitive without a large operation already in place.

But despite the challenges, Kenoteq is far from being the only company trying to make construction more sustainable. Other innovators include Qube, an India-based startup creating bricks out of plastic waste, and the ClickBrick which eliminates the use of cement through modular stacking (think real-life Lego).

There are signs of change. In Scotland, the government is reviewing a circular economy bill which encourages businesses to think creatively and economically about how they reuse and recycle materials. Boyle says that there are "contractors who would use [K-Briqs] tomorrow," if they were being produced on a large scale.

Over the next 18 months, Medero plans to get K-Briq machinery on-site at recycling plants. This will increase production while reducing transport-related emissions, she says, because trucks can collect K-Briqs when they drop off construction waste. "We need to have ways of building sustainably, with affordable, good quality materials that will last."

3 SLIDES © Kenoteq

Gabriela Medero and Sam Chapman, co-founders of Kenoteq, say they have created a sustainable alternative to traditional fired clay bricks.

China to report first population decline since 1949 despite relaxing one-child policy

Financial Times 4/27/2021


China is set to report its first population decline since records began in 1949 despite the relaxation of the government’s strict family planning policies, which was meant to reverse the falling birth rate of the world’s most populous country.

© Provided by National Post China’s birth rates have weakened even after Beijing relaxed its decades-long family planning policy in 2015, allowing couples to have two children instead of one.

The latest Chinese census, which was completed in December but has yet to be made public, is expected to report the total population of the country at less than 1.4 billion, according to people familiar with the research. In 2019, China’s population was reported to have exceeded the 1.4 billion mark.

Trade minister dodges questions on whether Canada has curbed potential forced-labour imports from China

The people cautioned, however, that the figure was considered very sensitive and would not be released until multiple government departments had reached a consensus on the data and its implications.

“The census results will have a huge impact on how the Chinese people see their country and how various government departments work,” said Huang Wenzheng, a fellow at the Center for China and Globalization, a Beijing-based think-tank. “They need to be handled very carefully.”

The government was scheduled to release the census in early April. Liu Aihua, a spokesperson at the National Bureau of Statistics, said on April 16 that the delay was partly due to the need for “more preparation work” ahead of the official announcement. The delay has been widely criticised on social media.

Local officials have also braced for the data’s release. Chen Longgan, deputy director of Anhui province’s statistics bureau, said in a meeting this month that officials should “set the agenda” for census interpretation and “pay close attention to public reaction”.

Analysts said a decline would suggest that China’s population could peak earlier than official projections and could soon be exceeded by India’s, which is estimated at 1.38 billion. That could take an extensive toll on the world’s second-largest economy, affecting everything from consumption to care for the elderly.

“The pace and scale of China’s demographic crisis are faster and bigger than we imagined,” said Huang. “That could have a disastrous impact on the country.”

China’s birth rates have weakened even after Beijing relaxed its decades-long family planning policy in 2015, allowing all couples to have two children instead of one. The population expanded under the one-child policy introduced in the late 1970s, thanks to a bulging population of young people in the aftermath of the Communist revolution as well as increased life expectancy.

Official data showed the number of newborns in China increased in 2016 but then fell for three consecutive years. Officials blamed the decline on a shrinking number of young women and the surging costs of child-rearing.

The real picture could be even worse. In a report published last week, China’s central bank estimated that the total fertility rate, or the average number of children a woman was likely to have in her lifetime, was less than 1.5, compared with the official estimate of 1.8.

“It is almost a fact that China has overestimated its birth rate,” the People’s Bank of China said. “The challenges brought about by China’s demographic shift could be bigger [than expected].”

A Beijing-based government adviser who declined to be identified said such overestimates stemmed in part from the fiscal system’s use of population figures to determine budgets, including for education and public security.

“There is an incentive for local governments to play up their [population] numbers so they can get more resources,” the person said.

The situation has led to calls for a radical overhaul of China’s birth control rules. The PBoC report suggested the government should “completely” abandon its “wait-and-see attitude” and scrap family planning entirely.

“Policy relaxations will be of little use when no one wants to have [more children],” the paper said.

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