Written by Pei-Chieh Hsu
Image credit: Provided by author. A screenshot from the Executive Yuan Post-Meeting Press Conference (3970th Meeting), from the policy press conference live stream on 18 September 2025.
Across the globe, the reliance on assisted reproductive technology (ART) to reproduce is growing. In 2019, the International Committee for Monitoring Assisted Reproductive Technology (ICMART) recorded 783,073 in vitro fertilisation (IVF) births, representing an estimated 90% to 95% of total global ART activity. While these figures highlight a significant global trend, the concentration of ART-conceived births is most pronounced in nations where significant pronatalist policies have been implemented to combat demographic decline.
In these contexts, government subsidy programmes do more than just lower the financial barrier to entry; they institutionalise ART as a standard pathway to parenthood. By de-risking the high costs of cycles, the state effectively encourages a structural dependence on medical intervention in reproduction, often outpacing natural conception rates among specific age groups. This ‘subsidised birth’ model creates a unique socio-technical landscape where the biological process of reproduction is increasingly intertwined with state-funded technological support.
While the global average of IVF-conceived births sits at approximately 0.54%, this figure masks the dramatic ‘fertility divide’ created by varying national policy frameworks. In countries with limited state support, such as the United States, ART births account for approximately 2.1% of total births. In contrast, nations that have integrated ART into their social welfare systems—such as Denmark, Spain, and Greece—report rates of 6% to 9%. This trend is perhaps most striking in East Asian nations like Taiwan and Japan; here, the integration of ART into broader pronatalist strategies has transformed medical intervention into a demographic necessity. In Taiwan specifically, expanded subsidies have pushed the proportion of ART-conceived babies toward nearly 10% of annual births, illustrating how the state can effectively ‘engineer’ a reliance on technology to sustain its future population. These disparities suggest that the ‘rise of assisted reproduction’ is not merely a biological or medical phenomenon but a direct reflection of how a state chooses to subsidise the technological creation of its future citizens.
The evolution of Taiwan’s In Vitro Fertilisation (IVF) subsidy scheme reflects a strategic shift toward a comprehensive pronatalist framework. Initially designed as a targeted social welfare measure for low-income households, the programme underwent a significant structural expansion in July 2021 and was further optimised in November 2025. The current programme provides universal financial support to all married couples—regardless of income—provided that at least one spouse is a Taiwanese citizen and the female partner is under 45. Under the 2025/2026 mandates, the government significantly increased funding to account for medical inflation and the delayed childbearing in the demographic trends. Official policy documents justify this universalisation as a response to the pervasive trend of delayed childbearing, aiming to bridge the gap between ‘fertility aspirations’ and biological constraints. For the first IVF attempt, general households receive a maximum subsidy of NT$150,000 if the female partner is under 39, and NT$130,000 if she is between 39 and 44. To encourage persistence while maintaining clinical safety, the policy utilises a tiered cycle cap: women under 40 are eligible for up to six subsidised cycles, while those aged 40–44 are limited to three cycles. Furthermore, the programme explicitly enforces a “Single Embryo Transfer” (SET) protocol for women under 39 to mitigate iatrogenic risks, such as multiple births and Ovarian Hyperstimulation Syndrome (OHSS). It effectively uses financial incentives to steer clinical practice toward safer neonatal outcomes.
The transformation of Taiwan’s IVF subsidy framework reflects a multi-dimensional policy logic that aligns with the three models proposed by Wu et al. (2020): Equal Access, Risk Prevention, and Pronatalism. By removing income barriers and universalising coverage, the state has addressed the ‘Equal Access’ model while simultaneously mandating single-embryo transfer (SET) protocols to satisfy ‘Risk Prevention’ objectives. However, recent longitudinal data highlight that the primary driver of this expansion is a robust ‘Pronatalist’ ambition. As demonstrated by Chen et al. (2025), this policy shift is not merely a social welfare expense but a strategic public investment. Their findings reveal that the 2021 subsidy changes yielded a 5.6-fold return on investment (ROI) for the Taiwanese government, based on the projected lifetime tax contributions of ART-conceived children. Together, these perspectives suggest that the growing dependency on ART in Taiwan is being structurally engineered by a state that views subsidised reproduction as both a demographic necessity and a long-term fiscal asset.
While Taiwan views IVF subsidies as a high-yield fiscal investment, the South Korean experience serves as a cautionary counterpoint. Despite substantial funding, the Korean model has experienced a continued decline in total fertility, suggesting that financial incentives alone do not address the underlying structural barriers to childbearing. The study highlights that these subsidies fail to address the underlying structural barriers—such as the high opportunity cost of childbearing and the intense labour market competition—that discourage younger women from entering the reproductive pool in the first place. Consequently, while Korea’s policy mirrors Taiwan’s ‘Pronatalist’ and ‘Risk Prevention’ models, it serves as a cautionary example that technological subsidies cannot compensate for broader social and cultural deterrents to family formation. An effective subsidy framework must move beyond simple cash transfers to ensure a diversified and high-quality reproductive infrastructure that aligns with the complex needs of modern families.
My fieldwork data on Taiwanese IVF experiences reveal a high level of consumer satisfaction, characterised by a distinct prioritisation of treatment efficacy. While respondents in the UK and Japan evaluate ART through the lenses of care quality and accessibility, Taiwanese users emphasise success rates as the primary metric for selecting clinics. This pragmatic ‘results-oriented’ approach is driven by the significant financial and emotional toll of treatment; as many survey participants noted, the high cost of IVF necessitates finding the ‘right’ clinic capable of achieving pregnancy ‘as soon as possible.’ Furthermore, because infertility is not universally viewed as a medical disease in Taiwan and falls outside the standard National Health Insurance remit, respondents highlighted a strategic reliance on finding the ‘right doctor’ to navigate a largely privatised medical landscape.
The definition of the ‘right’ doctor in the Taiwanese context is deeply social, often dictated by word-of-mouth reputation and fame within digital IVF communities. Although users do value care quality once treatment begins, the initial choice is almost exclusively driven by perceived professional authority. Interestingly, despite reporting limited face-to-face time with their physicians, Taiwanese respondents expressed a high degree of trust in the doctor-patient relationship, often preferring a model in which the physician leads the decision-making process. This satisfaction is further bolstered by the presence of ‘friendly’ support staff, such as nurses and consultants, who bridge the communication gap and optimise the overall patient experience.
Ultimately, these findings suggest that while subsidy policies and technological advancements have successfully lowered barriers for prospective parents, the current framework invites critical debate on several ontological and sociocultural issues. The expansion of ART in Taiwan does not merely solve infertility; it intersects with complex social beliefs regarding genetic continuity and eugenics and potentially reinforces the traditional link between formal marriage and legitimate childbearing. Moreover, the heavy concentration of high-end facilities in urban centres raises concerns about the unequal distribution of medical resources and the marginalisation of rural populations. As Taiwan continues to pursue its pronatalist strategy, further investigation is required to understand how these technologies may be inadvertently strengthening social hierarchies even as they fulfil individual reproductive aspirations.
Dr Pei-Chieh Hsu holds a PhD in Sociology from the University of Cambridge, earned in 2024. Her research contextualises the biopolitics of assisted reproductive technologies and reproductive decision-making in Japan and East Asia. She employed a mixed-methods approach to document the nuanced medical encounters through qualitative data and to measure decision-making via a quantitative survey. Her research highlights the intertwining relationship between medical knowledge, technological frameworks, and individual treatment decisions. Currently, she is a postdoctoral fellow at the Research Center for Humanities and Social Sciences in Academia Sinica.
This article was published as part of a special issue on Zeroing Fertility: Family-making and Future Parenthood