This is the fourth story in a series exploring how China’s decision to end the one-child policy has impacted Chinese society over the past five years. The policy change, which allowed every family to have two children, was announced on Oct. 29, 2015. View the entire series here.

Baishi Village, Shandong Province

At 11 a.m. on a December morning in 2013, migrant worker He Jingyun was on a bus to a new job when the shrill ring of his phone ripped him from his thoughts. It was his wife, Liu Guilan. She sounded distressed. He Xiwen, their 23-year-old only son, had been in a traffic accident in the distant province of Jiangsu, where he lived with his wife and daughter. He Jingyun thought about the car he and his wife had purchased for their son and felt a sudden pang of guilt.

Jingyun immediately returned back to his home in Shandong province, abandoning his job in neighboring Hebei. He often left the village of Baishi to find work, escaping the poorly paid farming or mining jobs that were his only options there. At home, he lived with his wife in a simple one-story house built around a concrete courtyard — a style typical of China’s northern farming villages. The family toilet was a hole in the ground located in a concrete shed off to one side of the yard, and inside the house magnolia paint was peeling off the bare walls.

The family led a humble life, and if Xiwen were seriously injured, Jingyun knew the cost of treatment would overwhelm them. Xiwen was covered by basic insurance, but he wouldn’t see any reimbursement until months later, and even then at only 70 percent of the total cost. The couple begged and borrowed 60,000 yuan ($9,270) from friends and family. Not having a car, they rented an unlicensed taxi and set off on the 650-kilometer drive to Jiangsu, telling friends that they were going to “save” their son. It was 2 a.m. when they finally pulled up outside their son’s house. From the car, they could see their daughter-in-law and her family illuminated by the headlights’ harsh white light. Reality hit. “If my son were still alive, everyone would’ve still been at the hospital,” Liu says. Xiwen, her only child, was dead.

There are no official statistics on the number of families in China that have lost only children. But according to a rough estimate in a 2012 article in Xinkuaiwang, a Guangzhou-based newspaper, it could be over 15 million. China passed its one-child policy in 1982, making it illegal for couples to have more than one child, in an effort by the central government to control population growth. The only exceptions were well-off families who could afford the fine, members of Chinese ethnic minorities, and, after a loosening of the policy in 2013, married couples where both spouses were themselves only children. With the policy in effect for 30-plus years, China’s population suffered an aging crisis, and on Jan. 1, 2016, the central government responded by implementing China’s new two-child policy to try to ease the demographic imbalance. Though the regulation is now history, the effects of the one-child policy live on through the lives of parents who lost their only child while living through it, and in the memories of the family planning officials who were tasked with enforcing it.

Huaihua, Hunan Province

One day in 2004, Han Shengxue was working in the office of the family planning committee in Huaihua City when a loud noise broke his concentration. Han left his desk and went to the lobby to see what was wrong and was confronted by a family in tears. “We obeyed the party’s orders,” they said. “But now our only child is dead. What are we supposed to do?” The parents were still young, so Han offered to accompany them to their home county and help them apply for a birth permit for another child. But he was shaken when he realized there would have been nothing he could have done if the couple had been too old to have another child.

Encounters with families at the office were a regular occurrence for Han. The family planning office was the only place people affected by the policy could go to register a number of grievances, which included difficulties with birth permits, contesting fines, or requesting financial assistance. Han was hardened to most complaints, but this time was different: It was his first close encounter with shidu families — or those bereaved of their only child during the one-child policy. Han saw in them a unique kind of suffering. “The sorrow these parents feel is unlike anything else,” he says. This belief sowed the seed of an idea in his mind — an idea that, after more contact with bereaved families, finally sprouted in 2010. It was then that Han embarked on a project to document the plight of China’s shidu families. In the five years since, 53-year-old Han has interviewed hundreds of families about the unique struggles they face, and in the process he has lifted the lid on a devastating but little-known side effect of the one-child policy.

Yangzhou, Jiangsu Province

He Xiwen’s head was crushed when a truck smashed into him on his morning commute. Longing for one final look at their son, He and Liu asked the police if they could see the body, but it was disfigured so badly the police refused. The couple protested, but the officers weren’t moved. “They intimidated us,” says He. “They shouted at us to leave.” Courts ordered the truck driver’s family to pay the couple 70,000 yuan in compensation, which He and Liu gave to their daughter-in-law and granddaughter. They returned to Shandong with Liu holding her son’s ashes in an urn on her lap. There was one small consolation for the couple: To save money on gas, their son had purchased a small motorbike, with a helmet, to get to and from work. The vehicle he was using at the time of the accident wasn’t his car.

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Old Buddhist superstitions linger on in China’s countryside, and some neighbors who had previously been friends began to shut He and Liu out, believing karma was punishing them for being bad people. The couple buried their son’s ashes in the field they used to grow crops, marking it with a small mound of earth. During those tough times, they only visited in the dead of night. “In the daytime I wouldn’t go out because I was worried about seeing people,” says He.

In March 2014, three months after their son’s death, Liu’s father was taken to the hospital and diagnosed with heart disease. While at the hospital caring for Liu’s father, the couple became acutely aware of all the sick old people surrounding them. A painful thought flashed in their minds: Who will look after us when we get old? With China’s weak social welfare system, they had pinned their hopes on their only child supporting them in old age, just like many other parents in China. Five years before their son died, He Jingyun’s younger brother passed away in a car accident. The loss of their son removed one more vital person from an already-small family support network. “We felt so much pressure thinking about growing old,” says He.

Huaihua, Hunan Province

Han has worked at the family planning committee in Huaihua since 1996. From offices like his all around the country, the one-child policy was implemented, and sometimes by force. Han, who is medium-height with a perfectly black mop of hair, is aware that he has been a part of the policy’s enforcement apparatus. “It is because of the policies the family planning department enacted that these people find themselves in this terrible situation,” he says. Han’s mid-level colleagues gave orders that were carried out by lower-level employees. But he doesn’t see a contradiction in his two roles. “I think it is our responsibility to also undertake this issue,” he says. “When shidu parents come to visit the department, they should be met with kindness.”

As the public relations officer for the Huaihua family planning committee, Han often put his journalism training to use writing press releases and news items for the committee. But he never dared to write about shidu parents officially because discussion of the one-child policy was taboo at the time. With nobody willing to give voice to the bereaved, their plight went largely unheard.

Though losing a child is painful for anyone, Han recognized that older shidu couples suffer the most. With their only child gone, and too old to have another, “It’s as if these people are being punished by God,” Han says. Despite wanting to help them, he found that many shidu families blamed him and his department for their troubles, and they refused to talk to him. “Many of them were closed off,” he says. “They would hide inside and not open the door or allow me in.”

So Han switched tack. When he qualified as a reporter, he was given a license. Han used this license to pose as a journalist in order to get access to shidu parents. The strategy worked, and Han was allowed in to talk to many bereaved families. By the time he disclosed that he was also working for the family planning committee, any suspicion from the parents about his intentions had dissipated.

Progress was still slow, however. In 2014 Han heard about an unofficial association for shidu families in Huaihua and knew that he had to get in touch. He contacted the founder, Nie Heping, herself a shidu mother in her 60s. She agreed to ask the families in their online chat group if they’d be willing to meet Han, but because of his job at the family planning committee, everyone refused. It wasn’t until Nie invited him to a group barbecue, and the families were able to see the real nature of his intentions, that they opened up to Han and let him into their lives.

Financial assistance for shidu parents is limited. In 2013 China’s public health and family planning committee set a nationwide policy that financial aid could only be given to shidu parents if the female partner was over 48 years old. The rationale was that younger couples were in a better position to find work and have another child. Parents who qualified for benefits would receive a monthly minimum of 340 yuan. The central government sets the bare minimum that can be awarded, though local governments are free to award more if they choose. But without pressure from those higher up, most do nothing.

Baishi Village, Shandong Province

With Xiwen gone, He and Liu didn’t qualify for welfare subsidies because, at the age of 43, they were deemed too young. With no other option, they decided to try for another child in an attempt to safeguard their future. In the course of a few months they visited over 10 different hospitals, following recommendations from friends and family. “As soon as we had money, we would go to another hospital,” says He. But nothing worked. They spent 10,000 yuan on a fertility diagnosis, but the hospital declined to operate because of their age. That year He’s corn crop made a profit of only 1,000 yuan. Dejected and in debt to friends and family, they returned home.

But He and Liu never gave up hope. In July 2014, a TV commercial for the Red Cross hospital in Jinan, also in Shandong, kicked their resolve into gear again. “We weren’t ready to accept our fate,” says He. “So we decided to try once more.” They made the three-hour bus trip to Jinan, almost not daring to hope for the best. The Red Cross hospital in Jinan started a national initiative in 2014 that, through free diagnosis and surgery, gives bereaved parents from China’s poorest areas a second chance at having a child. It was the couple’s last hope.

On July 7, 2014, He and Liu went to the hospital and saw Dr. Wu Min, who told them the hospital could perform surgery on both of them that would increase their chances of getting pregnant. But at 43 years old, Liu was at greater risk of experiencing complications such as diabetes or high blood pressure, or of having a child with birth defects. Wu stressed the risks to Liu’s health and asked if she was absolutely certain that she wanted to proceed. “Doctor,” Liu said, tightly gripping Wu’s hand, “I’m willing to lose my life so that I can give my husband a child.”

Later that month, the surgery was completed without a hitch. Because of high costs, the Red Cross hospital doesn’t offer in vitro fertilization, which has a pregnancy success rate of 30 to 40 percent. Instead they provide other surgical approaches free of charge, but the chance of pregnancy is only around 10 percent. Because of this low success rate and their age, the couple decided to forego a recuperation period and try for a child immediately after the surgery. In August they went back to the hospital for a checkup and were astonished to discover that Liu was pregnant.

Huaihua, Hunan Province

Over the past 18 months Han’s work has attracted so much attention from national media that he has been inundated with calls from shidu parents desperate to tell him their heart-wrenching stories. Han vividly recounts the story of a mother who couldn’t sleep one night after her son died, so she logged into his social media account and posted a status update. “The flashing of the profile picture made her feel as if he were still alive,” Han says. As he sat in his study late one night writing the story down, tears fell down his cheeks.

In Huaihua Han’s bosses had been paying attention. News of his project reached the leaders, and Han was invited to give a presentation to a selection of Huaihua’s Communist Party county secretaries. Moved by the stories he told, Han’s bosses gave their tacit approval to his work by setting a monthly allowance of 800 yuan across both urban and rural areas for shidu parents in Huaihua — well over double the national minimum allowance. But according to Han there is still much work to be done, as many people are not even aware that any financial help exists.

On the night of Oct. 29, 2015, Han was sitting on the sofa with his wife. They were watching the news when the announcement that China was ending the one-child policy came on. “I was so happy I jumped up off the sofa,” Han says. The government’s policy change has significant implications for shidu families. “One-child families are always at risk of losing their only child,” he says. “With the two-child policy, these at-risk families will become fewer and fewer.”

Han believes it’s possible that, with time, the problem of shidu parents may disappear completely. Meanwhile, he is pressing ahead with his labor of love: He hopes to publish a book on the stories of shidu parents by the end of 2016. The work touches on potentially sensitive areas of government policy, prompting some in Han’s family to worry that he may “run into trouble.” But Han promises to be careful and is confident that his book won’t ruffle many feathers. “I’m not unfair to anyone,” he says. “I haven’t opposed family planning policies or criticized anyone. I’m only trying to reflect the heartbreaking reality these families face.”

Baishi, Shandong Province

In May 2015 He Zhengqian was born by caesarean section in a local hospital. As a baby he was healthy, if a little underweight. The Red Cross initiative was the first of its kind in China, and He and Liu were the first couple to get pregnant because of its work, attracting the attention of Chinese media. A crew from CCTV was present for the birth. But the joy didn’t last long. “After our son was born, he was taken to the intensive care unit,” says He, letting out the sigh of a defeated man. “One day in intensive care costs over 1,000 yuan. Our son had to stay there for nine days.”

Ten months later, Zhengqian is curious and playful like most other children his age, but because of frequent hunger, his day is punctuated with more cries than the average child. During the day, He and Liu feed their son whatever they can afford: steamed buns, corn meal, even cheap potato chips. In the early months of his life, Zhengqian lost clumps of hair because of malnutrition, and Dr. Wu compelled He and Liu to feed their son pork soup. But they can’t afford this, having never even eaten it themselves. They don’t have money to buy milk powder either, but Liu’s younger sister sometimes sends it to them from her hometown via bus. To ration this precious resource, the milk powder is only given to Zhengqian as a last resort — when he wakes up crying in the middle of the night.

Zhengqian’s birth was the end of a long and expensive journey for He and Liu. But the initial elation has now given way to a stark financial reality. Suffering from a pain in his waist, He is finding it difficult to do manual labor — something he knows needs to change. “After Spring Festival I’ll go and work at the quarry part-time,” he says. “But I have no way to take on long-term jobs. I have to come home to look after my wife and child.” With the family’s savings gone, the arrival of a baby has been a huge burden. He often feels conflicted about their choice. “I still don’t know if having this child was the right thing to do,” he says. “Zhengqian needs raising, and my mother and my wife’s father both need looking after. I have no idea how we’re going to cope.” As He speaks, it’s as if each tear is slicing into the coarse skin on his face. “I don’t dare think whether we’d be better off dead — there’s no use thinking about that.”

With additional reporting by Fu Danni.

(Header image: He Jingyun walks to his son’s grave near a farm in Jining, Shandong province, Jan. 7, 2016. Gao Zheng/Sixth Tone)