After six months of self-imposed seclusion following the unexpected death of her son, Zhang Liying was determined to muster the courage to have another child.
"We need to move on, and a child is necessary for my life," said the 40-year-old from the Baqiao district of Xi'an, Shaanxi province, whose son drowned in 2012 at the age of 20.
Life went into suspended animation from that moment. "I saw no reason to live on. I felt ashamed at losing my son and thought it must be my fault," she said.
However, Zhang gradually became more optimistic after she was approached by family planning workers who offered care and support, including peer-support activities, mental health intervention and a free course of assisted reproductive technology.
"Without government help, a farming family like us couldn't afford the treatment, which costs about 50,000 yuan ($8,000)," she said.
Zhang and her husband are not alone, according to Jia Wenying, head of the Baqiao family planning bureau, who said 137 couples in the district have lost their only child through illness or accident.
Factory worker Hua Jie said she cried so much when her depressed daughter committed suicide at the age of 26 that her eyesight was affected. "I put away all her photos but couldn't help sobbing when I saw other women of a similar age to my daughter," said the 58-year-old.
To some extent, Hua has been fortunate: Following their daughter's death, her husband refused to bow to grief and tried to remain positive and optimistic, said Ding Baorong, a bureau worker who has provided care for more than 100 bereaved families.
In many cases, bereaved couples blame each other for their loss. That makes the marriage unsustainable and usually results in divorce.
With a combined monthly wage of about 4,000 yuan ($645), Hua and her husband, surnamed Feng, enjoy a relatively comfortable life, but they are apprehensive about the future. "We are concerned about when we get old and can't take care of ourselves," said Feng. "By that time, our wages won't even pay for two beds at a decent rest home in Xi'an. I hope the government will help us if that happens."
They have never linked their personal tragedy with China's family planning policy, which was introduced in the late 1970s and limited most couples to just one child. "But given the opportunity, I would certainly have had more than one child," said Hua.
According to Jia, nearly 50 percent of bereaved one-child couples in Baqiao district are urbanites aged between 50 and 60.
"They are more in need of mental consolation than financial support," she said, citing a 2012 survey conducted by the China Family Planning Association as part of a three-year project to explore models of care and support for parents whose only child has predeceased them.
To date, more than 70 regions nationwide have participated in the project. Each region receives an annual care-and-support subsidy of 200,000 yuan on condition the local government provides an equal amount, according to Yang Yuxue, executive deputy director of the association.
"The project was designed as a catalyst to encourage local governments to provide long-term, sustainable care for bereaved parents," he said.
A valuable lesson
Ding devised a questionnaire to accompany the survey. It contained more than 20 questions - including basic information about economic situation, marital status and the couple's emotional state - designed to help carers understand the plight of bereaved parents and cater to their needs.
However, some parents saw the questionnaire as an unwarranted intrusion into private grief. "One woman called Ni, who lost her 20-year-old daughter to bone cancer and subsequently divorced, turned us away from her door when we tried to give her the questionnaire. She taught us a valuable lesson and prompted changes in the way we work with bereaved parents. We understood that we had to listen more and be more respectful," Ding said.
When Ding visited Ni a second time, the distraught mother burst into tears and began to explain her feelings. Ni became a volunteer worker for the project and helped to set up an online chat group to allow the exchange of information and provide peer support for families in the district. In addition, the group organizes offline activities such as get-togethers and physical checks to provide contact and emotional support, Ding said.
"There are various rules we must recognize when we offer care," she said, explaining that bereaved parents should never be visited by large groups of carers because they don't want to draw attention to themselves.
One woman in Baqiao refused to visit her family for 15 years after her 22-year-old son was killed in an auto accident, Ding said. She added that it's common for bereaved parents to confine themselves to their homes for a period of time. "They don't want other people to know anything, not even their close relatives."
Tu Hongzhu, head of the secretariat of the Family Planning Association of Xi'an, said appropriate intervention is necessary to safeguard distraught parents from irrational behavior that can be prompted by grief.
Ni was faced with a medical bill of more than 400,000 yuan when her daughter died in 2008. As a textile worker, the sum was far beyond her means, so she asked her relatives for loans. She broke off relations with almost all who refused.
"Peer support, communication and activities organized by the project help to heal bereaved parents emotionally," Tu said, adding that the parents don't like to see too many people. "They prefer a regular and relatively exclusive circle."
Ding believes care and support should be provided moderately, but sensitively. "We always visit during traditional festivals or if they fall ill, but we never disturb their normal lives in the name of care," she said.
Tu echoed Ding's view, adding that couples in the autumn of their years face great difficulties obtaining care, and require medical treatment, mental and emotional support.
Hua said: "I don't fear death, but the thought of getting old and falling ill upsets and horrifies me."
Ding urged decision-makers to look into the problem as quickly as possible.
"When these people enter old age in five to 10 years' time, they will require daily care. Are we preparing ways to handle the problem and assure them of a decent life when that happens?" she asked.
When they turn 60, every bereaved parent in Xi'an receives a monthly allowance of 900 to 1,000 yuan.
"That figure rises by 100 yuan when they get to 70," Tu said.
"Preparations are now being made, particularly in terms of medical treatment and care for the elderly, otherwise it will be too late," he noted, adding that 40 percent of bereaved couples in the city are aged 60 or older.
The local government grants bereaved single-child parents a one-time subsidy of 20,000 to 30,000 yuan, and women younger than 49 are encouraged to undertake a free course of assisted reproductive technology to help them have another child, he added.
Moreover, local mental health teams have been integrated to ensure professional psychiatric intervention, he said.
According to Ding, about 10 percent of Baqiao's bereaved couples are willing to accept the services.
A micro loan program has been introduced to encourage unemployed bereaved parents to start small businesses and become more involved with society, she added.
Moreover, as a pre-emptive measure, the local government has introduced and subsidized voluntary commercial insurance policies among all parents involved in the family planning project whose child is aged 16 or younger. The policies cover a range of major illnesses and accidental injuries and death.
Each participating family pays an annual premium of just 10 yuan, and the local government provides a subsidy of 40 yuan.
Of the 385,000 eligible families in Xi'an, more than 70,000 are now covered by the plan. "A further 140,000 are expected to be included by the end of the year," said Tu, who added that the local government's subsidy policies for bereaved families are uniform across all districts, but the means of delivering care and support vary according to need.
"The policies must be fair, open, and equal to all, otherwise mistakes could occur and that would cause the families more mental anguish," he said.
A family planning official surnamed Sun in the Hedong district of Tianjin, which participates in the family planning association's project, said there are about 200 bereaved parent families locally.
However, the amount paid as a one-time subsidy varies from district to district within the municipality, which has provoked group protests for equal treatment, he noted.
"A uniform policy within the city would at least help to ensure that the work runs smoothly," Sun said.
People suffering serious physical or mental problems, the elderly and those facing economic hardship are given top priority, he added.
In 2013, Hedong paid a monthly allowance of 200 to 270 yuan to bereaved parents, providing the wife was 49 or older. "The reality is that the relatively rich get more subsidies. The central government should introduce policies and coordinate action to change the situation," Sun said.
Wang Haidong, director of the family planning and family development department at the National Health and Family Planning Commission, said the department is mulling national policies to better address the problem and provide improved care for bereaved parents.
According to Wang, more than 400,000 bereaved parents nationwide are covered by a special assistance program. Although he was unable to say precisely how many couples have lost their only child nationwide, some experts estimate the figure to be more than 2 million, and the commission's 2010 yearbook revealed that about 76,000 families on the Chinese mainland lose their only child each year.
"These people have contributed to the country's overall economic and social development by adhering to the family planning policy. Now, having lost their only child, they are encountering difficulties, so the government must lend a hand," he said.
Ding cited a November announcement that the family planning policy will be relaxed to allow some couples to have two children. "Things are improving. It's a good start, but we must not simply leave the past behind. Bereaved parents deserve consideration from the government," she said.