One Child Policy:
impacts on reproductive healthand attitudes
Therese Hesketh
UCL Centre for International Health and Development
The One Child Policy has directly affected the lives of over one fifth of the world’s population for 30 years
Overview of the presentation
How the Policy has reduced reproductive choice How the Policy has come to be accepted The impact of the Policy
demography and gender benefits negatives
Attitudes Policy family size
Policy What is changing?
POPULATION GROWTH
580
630 715 81
8 916 981
0
250
500
750
1,000
1950 1955 1965 1970 1975 1980
Population (000's)
Source: World Bank
Why the Policy?
“There can never be too
many Chinese” Mao Ze Dong
Population increase 1950-
70 because of high fertility,
improved survival
By late 70s 2/3 of the population under 30
In 1979 population containment seen as essential to economic reform and improvement in living standards
Policy works through reducing reproductive choice
A set of rules and regulations governing approved family size
The State Family Planning Bureau sets targets and policy direction
Implementation of policy is the responsibility of family planning committees at provincial and county level
Local officials responsible for day-to-day implementation
The Policy – how it works
Late marriage Births permitted only within marriage One child rule applies to urban areas and
government workers Two children allowed in most rural areas In some rural areas a second child is allowed
only after the birth of a girl Local quotas previously in force in many areas
XINJIANG
QINGHAI
NEI MONGOL
GANSU
NINGXIA
SHAANXIXIZANG
SICHUAN CHONGQING
YUNNAN
GUIZHOU
GUANGXI
HAINAN
TAIWAN
HUNANJIANGXI
ZHEJIANG
FUJIAN
GUANGDONG
HONG KONGMACAU
Shanghai
SHANGHAI SHI
Guangzhou
Chengdu
JIANGSU
ANHUIHUBEI
HENAN
SHANXI
SHANDONG
Beijiing
Shenyang
HEBEIBEIJING SHI
TIANJIN
LIAONING
JILIN
HEILONGJIANG
Provincial Policies
Relaxed 1 Child Policy
Medium 1 Child Policy
Strict 1 Child Policy
Policy underpinned by easy access to contraception and abortion
Contraception use of married Chinese (%)
1992 1997 2005 Male sterilisation 12 9.2 7.5 Female sterilisation 42 40 37 IUD 40 43 46 Condom 1.8 4.0 5.6 Oral contraception 3.8 2.1 2.5 Other 0.8 1.3 1.3
How does the Policy work for individuals?
Late marriage After first child IUD inserted-usually at
delivery In rural areas IUD removed for second child
after 4-5 years – sometimes only if first is a girl
If pregnancy “outside the Policy” abortion is necessary
Later sterilisation
Benefits of the Policy
+ Prevented around 300m births
+ Helped to lift over 200m people out of poverty
0
2
4
6
8
1960
1962
1964
1966
1968
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
TFR
Has reduced Total Fertility Rate
Late
, L
on
g, F
ew
On
e C
hil
d
P
oli
cy
Gre
at
Leap
F
orw
ard
TFR7.
6
5.2 5.3
6.5
2.9
2.5
1.7 2.
1
5.0
1.9
1.6
1.2
1.0
2.8
1.7
0
1
2
3
4
5
6
7
8
China Singapore Hong Kong India UnitedKingdom
1962 1980 2005
Source: World Bank
And compared to other nations
How did the Chinese achieve acceptance of the Policy?
Timing Incentives and Penalties Propaganda
Carrots and sticks
Rewards: economic incentives, low interest loans, preference in schooling, health insurance
Penalties: fines, confiscation of belongings,
loss of employment
Considerable social pressure to comply
Now widespread acceptance
Propaganda
Propaganda -massive campaign focusing on:
- societal dangers of overpopulation
- the personal material benefits of having only one child
- quality of the offspring
The other side of choice: gender preference
Son preference very common in pre-Communist China led to infanticide and neglect of girls resulting in skewed sex ratio
During Mao years less obvious and sex ratios within normal limits (at birth 103-107)
NOW sex ratios have risen - caused by: Son preference Access to abortion Low fertility
Sex Ratio at birth in China since onset of Policy
SEX RATIO AT BIRTH
100
105
110
115
120
125
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Sex
-sel
ecti
veA
bo
rtio
n
XINJIANG
QINGHAI
NEI MONGOL
GANSU
NINGXIA
SHAANXIXIZANG
SICHUAN CHONGQING
YUNNAN
GUIZHOU
GUANGXI
HAINAN
TAIWAN
HUNANJIANGXI
ZHEJIANG
FUJIAN
GUANGDONG
HONG KONGMACAU
Shanghai
SHANGHAI SHI
Guangzhou
JIANGSU
ANHUIHUBEI
HENAN
SHANXI
SHANDONG
Shenyang
HEBEIBEIJING SHI
TIANJIN
LIAONING
JILIN
HEILONGJIANG
Sex ratio in 1-4 age band
110 - 120
120 - 130
> 130
< 110
XINJIANG
QINGHAI
NEI MONGOL
GANSU
NINGXIA
SHAANXIXIZANG
SICHUAN CHONGQING
YUNNAN
GUIZHOU
GUANGXI
HAINAN
TAIWAN
HUNANJIANGXI
ZHEJIANG
FUJIAN
GUANGDONG
HONG KONGMACAU
Shanghai
SHANGHAI SHI
Guangzhou
Chengdu
JIANGSU
ANHUIHUBEI
HENAN
SHANXI
SHANDONG
Beijiing
Shenyang
HEBEIBEIJING SHI
TIANJIN
LIAONING
JILIN
HEILONGJIANG
Provincial Policies
Relaxed 1 Child Policy
Medium 1 Child Policy
Strict 1 Child Policy
SRB by birth order rises dramatically in some provinces Source: 2005 1% survey
First Second Third
Anhui 107 190 227
Jiangxi 108 178 206
Henan 104 166 176
Guangdong 108 146 167
Hainan 111 138 142
Problems of excess males
Men: problems of partners/marriage, mental health problems, socially disruptive behaviour
Daughters more valued because not competing with sons. Female education levels increased
But…trafficking, selling of women as brides
The reproductive health benefits
Fewer pregnancies Safe, legal abortion
Work and education: acquire skills, education and training
Women’s status increased
On the negative side
Forced abortions/ pressure to have abortion Problems with unapproved pregnancies:
women with unapproved pregnancies less likely to seek antenatal care or to deliver in a modern medical facility
Lack of choice in contraception 80% of women interviewed for the NFPRHS
(2001) said thay had no choice in contraception
Attitudes
To family size
To the Policy
Attitudes to family size
Women's preference for family size (n=39,354) 5.
9%
5.6%
0.7%
45.5
%
0.7% 3.5%
36.7
%
0%
10%
20%
30%
40%
50%
60%
F M FF FM MM 3 + Onenopref
Source Ding & Hesketh 2006
Attitudes to the Policy: qualitative study
It is necessary- too many Chinese One child is enough Not equitable Not aware that other countries have no restrictions Life has changed – the Policy is not necessary
anymore Policy is getting more difficult to enforce It’s bad when people can break the rules and get
away with it Even if there is a limit on the number of children
there should be choice about when to have them
Abortion
It is good that abortion is easy to get. Bad that there is sometimes pressure to have
abortion If you know you’re going to have an abnormal
child it is best to have an abortion Sex-selective abortion is wrong. People who do sex selective abortions
should be punished
What is changing?
More choice in contraception
Relaxation of the policy
Campaigns to promote the girl child
END