As the 2020 census shows a falling fertility rate in China, Chinese millennial couples are reluctant to have children as the lack of affordable public healthcare, rising living costs and grueling hours are worrying the world's most populous country.

Citing a March survey of 1,938 individuals, South China Morning Post (SCMP) reported that 67.3 per cent of young people said the inability to find domestic help was the number one reason they were unwilling to have a second child.

On the other hand, 61.7 per cent cited high financial pressure, followed by a lack of safe and appropriate nurseries at 54 per cent, higher demand for housing at 41.6 per cent, while 24.3 per cent cited the impact it could have on a woman's career and employment opportunities.

Getty He, a human resources manager from China's Guangzhou, said: "For working class families like us, it's not practical and affordable to hire a nanny that usually costs 6,000 yuan (USD 9,333) or above each month, which accounts for more than half of my after-tax income. I'm also worried about handing over my baby to a stranger."

It is more expensive to hire a domestic maid in China, as compared to a foreign maid in many other developed Asian cities, due to a shortage of live-in helpers. Disposable income per capita in China's major cities lags far behind Singapore and Hong Kong, SCMP reported. A 2019 report by a Chinese online recruitment platform predicted continued shortfall in domestic helpers to 30 million by next year.

"The monthly salary of a nanny keeps soaring. According to industry insiders, 10.4 families compete for an experienced nanny in first-tier cities… It now costs 5,500 yuan per month for daily housework.

If there is a child under 6 years old, it costs 6,000 yuan to 7,000 yuan … an infant under 3 years old, at least 8,000 is required," said Hu Zijian, who runs Anxindaojia Ltd, a housework employment agency in Guangzhou. Meanwhile, childcare for children under the age of three is lacking in particular, especially in rural areas – as only 4.71 per cent of children admitted to nurseries in 2019 were under three years old, which is far below the European Union (EU) average of 35 per cent.

Huang Wenzheng, a demographer, said China would have to build around 100,000 childcare centres to increase the nursery enrolment rate of children below three years old to 50 per cent, SCMP reported.

In 2019, China's female labour rate was about 61 per cent, higher than the United States on 57 per cent, Japan on 54 per cent or 21 per cent in India, according to the World Bank.

According to the seventh nationwide census of 2020, China's population has grown by merely 5.38 per cent over the last 10 years. China's birthrate has been on the decline since 2017, despite easing of the 'one-child policy' in order to avert an incoming demographic crisis.

China's one-child policy, implemented in 1979 and withdrawn in 2016, had exacerbated the practice of sex-selective abortion in favour of boys, said Jiang Quanbao, a demography professor.