This study reviews the institutional factors that have influenced the fertility and family trends in five East Asian societies that experienced a precipitous transition to very low fertility: China, Japan, Hong Kong, South Korea and Taiwan. The paper begins by outlining the unique family formation patterns of these societies and the existing explanations for their observed ultra-low fertility levels. In particular, it highlights the role of Confucian culture, which emphasises patriarchal values and credentialism, in shaping the current state of low fertility in East Asia. For example, the ways in which Confucianism affects women's roles at home, the effectiveness of pronatalist policies and the burden of human capital investments among parents are discussed. With these contextual factors and the current very low fertility rates as a backdrop, this study also examines attitudinal changes in marriage and family values that have taken place in these societies after the new millennium. These changes could further erode the traditional family and influence family formation trends in the future. The article concludes by discussing recent policy responses and the possible future of fertility in East Asia.