In October 2015, China’s ‘one-child policy’ was replaced by a universal two-child policy. The impacts of the new policy are inevitably speculative, but predictions can be made based on recent trends. The population increase will be relatively small, peaking at 1.45 billion in 2029 (compared with a peak of 1.4 billion in 2023 if the one-child policy continued). The new policy will allow almost all Chinese people to have their preferred number of children. The benefits of the new policy include virtual elimination of abortions of unapproved pregnancies and problems of unregistered children and a lower sex ratio at birth – all of which should improve health outcomes. Impacts of the new policy on the shrinking workforce and rapid population ageing will not be evident for two decades. In the meantime more sound policy actions need to be taken to meet the social, health and care needs of the quickly growing elderly population. About 45 per cent of China’s population currently live in rural areas, where the potential is great for fertility increase to enrich the future workforce and cumulate pension premium funds from young farmers (who previously have not participated in old-age insurance programmes). China’s current low retirement age and cultural tradition of familial care for the elderly could provide useful potential opportunities to address ageing problems. In conclusion, we believe that if (and only if) the universal two-child policy is thoroughly and quickly implemented and other needed policy actions are taken, China should be able to face the serious challenges of population ageing.