I started my career as a gynecologist 17 years ago at the Xuzhou Maternal and Child Healthcare Hospital in Xuzhou, Jiangsu province. Since then, there have been many changes in the patients I see. The number of women who find getting pregnant difficult or are infertile has risen rapidly, and the age of my patients has risen, especially since the beginning of the year when the universal two-child policy was adopted.

Before, most of my patients were about 35, but now the average age is about 37 and sometimes I even see patients who are older than 50.

They don't only come from Jiangsu province, but also from neighboring Shandong, Henan and Anhui.

I think the universal two-child policy is the major cause of the rise in the age of the patients I now see.

For decades, most urban couples were only allowed to have one child, but now they are allowed to have two, which has resulted in many older couples trying every means possible to have another baby.

Moreover, some people who have lost their only child to accident or illness will try their best to have another, even if their advancing years make pregnancy difficult and risky.

Now, nearly half of the women who come to see me about reproductive difficulties resulting from factors such as illness or malfunction are hoping for a second child.

Before, nearly all of my patients were having their first child.

The maternity mortality rate has risen this year, which is rational because of the number of women with higher levels of risk during pregnancy, such as older women, has risen suddenly.

I think most of the deaths happened at smaller county-level hospitals.

In addition, I have seen more infertile women, or women whose difficulties were caused by repeated abortions, than in previous years.

People's minds are becoming more open and premarital sex is common.

However, abortion can greatly reduce a woman's chances of getting pregnant, and some even cannot get pregnant with in vitro fertilization.

Because surrogacy is illegal in China, many couples seek surrogate parents in countries such as Thailand.

Many gynecologists at big hospitals are struggling with the rise in patient numbers, and some are under great stress.

I think gynecologists are kept busier than most other doctors, and it is very common for them to work long hours, because babies are born at all times of the day and night.

I think the situation will improve in the next few years, especially as the National Health and Family Planning Commission has promised to train more doctors and nurses and to raise the number of beds in obstetrics departments.

He Wenjie spoke with Wang Xioadong.

He Wenjie, gynecologist at the Xuzhou Maternal and Child Healthcare Hospital in Jiangsu province.