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