When fewer children mean shorter lives: Fertility policy and elderly well-being in China

We study the long-run consequences of fertility policy for aging and survival, exploiting the staggered provincial rollout of China's 1970s Later, Longer, Fewer campaign. Linking variation in exposure to the Chinese Longitudinal Healthy Longevity Survey (1998-2021), we find that cohorts subject to fertility restrictions experienced significantly higher late-life mortality, over 10% on average, and worse cognitive and psychological outcomes. These effects arise because smaller sibships, delayed childbearing, and wider spacing reduced both the supply and timing of intergenerational care. While the subsequent introduction of LTCI mitigated some adverse impacts, the effects were driven by in-kind benefits, whereas cash-based LTCI provided little offset, underscoring the limits of formal substitution for kin-based support. Our findings reveal a fundamental intergenerational trade-off in fertility control and highlight the enduring demographic costs of policies that reshape family structure.