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It is within this context that The BMJ publishes a collection examining women’s health in China (https://www.bmj.com/collections/womens-health-in-china). Women are now healthier than ever in China, but there are also new challenges and changing social norms and expectations. In nine articles spanning topics and conditions across women’s life courses, experts from China analyse the current state of women’s health; review achievements and remaining challenges in the contexts of women’s empowerment and rights, labour force participation, and family and community dynamics; and make recommendations for promoting women’s future health, with a focus on sexual and reproductive health. Such a focus is necessary because of the immediate context of falling fertility.6 In 2022, the fertility rate in China dropped to 1.1% and for the first time in decades became lower than the country’s overall mortality. In the meantime, the percentage of people aged 65 years or older reached its highest level (14.9%), setting a new challenge for health systems and delivery in the country.

ertility.6 In 2022, the fertility rate in China dropped to 1.1% and for the first time in decades became lower than the country’s overall mortality. In the meantime, the percentage of people aged 65 years or older reached its highest level (14.9%), setting a new challenge for health systems and delivery in the country. As the economy grows and China’s culture becomes more westernised, women have become sexually more active but less interested in marriage and parenthood. These changes, and importantly the social norms and freedoms that shape them, have become important determinants of women’s health. Furthermore, delayed parenthood, decreased fecundity, and increased access to assisted reproductive technologies have health effects for both mothers and children. As a consequence, China faces great challenges in formulating its new population strategies and maternal and child care policies, argue Wang and colleagues.7 Historically, maternal health risks have been a serious threat to women’s lives. China has made incredible strides in reducing maternal mortality,8 but at the same time, these successes also make it more difficult for future efforts to have an impact. The current low fertility may provide a window of opportunity, Shi and colleagues argue, for improving the quality and equity of maternal care, partly by setting up a learning system for quality management and regional networks that can provide integrated maternal care.8

difficult for future efforts to have an impact. The current low fertility may provide a window of opportunity, Shi and colleagues argue, for improving the quality and equity of maternal care, partly by setting up a learning system for quality management and regional networks that can provide integrated maternal care.8 Increased sexual activity, decreased fertility, and delayed parenthood all require a shift in focus for contraceptive services in China, Zeng and colleagues argue.9 The rising abortion:birth ratio, which reached a historical high of 0.75 in 2020, and the resurging incidence of sexually transmitted diseases, they believe, point to the urgent need for more comprehensive and effective contraceptive services.

ft in focus for contraceptive services in China, Zeng and colleagues argue.9 The rising abortion:birth ratio, which reached a historical high of 0.75 in 2020, and the resurging incidence of sexually transmitted diseases, they believe, point to the urgent need for more comprehensive and effective contraceptive services. In addition to a focus on sexual and reproductive health and rights, other articles in the collection examine approaches to deal with the growing burdens of non-communicable disease in women. These include screening for cervical cancer and postpartum depression, and strategies for reducing cardiovascular diseases and type B hepatitis infections in women.10 11 12 13 Effects on mental health are discussed in relation to the growing capabilities of genomics to screen and prevent birth defects, which put considerable psychological burdens on mothers and families.14 Further still, challenges embedded in social, political, economic, and cultural contexts and their solutions require changes well beyond healthcare. For example, egg freezing for non-medical reasons is highly controversial and currently illegal in China. For women’s rights and career aspirations, these restrictions should be lifted.7

challenges embedded in social, political, economic, and cultural contexts and their solutions require changes well beyond healthcare. For example, egg freezing for non-medical reasons is highly controversial and currently illegal in China. For women’s rights and career aspirations, these restrictions should be lifted.7 Domestic violence is another serious concern for women in China. Domestic violence includes physical, sexual, and psychological harms and was estimated to affect at least 25% of women in 2023.15 The problem is, however, mostly hidden because in the Chinese culture it is often perceived as a family affair and deemed shameful by the family and woman experiencing abuse. Liu and colleagues suggest that mental health workers may have an important role in breaking the silence and helping those affected.15

Promoting women’s health in China, as elsewhere, demands that women’s rights and status are not overlooked as broader social changes accelerate the wealth and development of a country as large and vital as China. Efforts must ensure that girls and women have access to education and leadership opportunities, new digital technologies are harnessed to empower girls and women while safeguarding their wellbeing, and the impacts of growing challenges like climate change and migration are examined with a gender lens. Existing inequities between rural and urban women, those in different cultural and ethnic groups, and those across regions and groups of different economic levels must be addressed before they widen alongside the country’s overall wealth and economic gains. Our aim with this collection is to contribute to the conversations and analysis of gender equality in China, and to stimulate more discussion to ensure evidence based interventions are developed and implemented fairly so that women can hold up half the sky.