China is a country famed for many things and unfortunately their attempted control of total fertility rates through the ‘One child policy’ is one of the most notorious things.
Both during the 1950’s and 60’s China had made an attempt to control its population growth rate through family planning policies but when that didn’t work a much more relentless scheme was introduced in 1971 by their leader, following the slogan wan, xi, shao (late, spaced, few).
Initially the rules weren’t as strict and two children were permitted, just below the replacement level. In order to achieve this aim the marriage age was raised to 25 for women and 28 for men and a minimum space of three to four years between children, in the hope that postponement would naturally limit the fecund time a women could have children in.
When the effects weren’t evident enough the more severe one child policy was introduced, limiting the amount of children to one per family and applying just as strictly to urban and rural areas regardless of whether the first child was a boy or not. This led to an average TFR of 1.62 and had a significant impact on social and economic factors both in the short term and the long term.
In rural areas the TFR fell from 5.4 to 1.8, a major reduction between 1971 and 1999. There are regional variations, which were as low as 1.1 in Hong Kong. In order to meet the reductions in the TFR there were extreme and violent measures taken to enforce the policies. (Attane 2002). In some rural areas there was a slight relaxation of the policy in that if the child was a girl then there could be a second birth after five years in the hope of having a boy that was wanted for various cultural reasons.
In total at least 87% of women were forced into using contraception, many of them long term forms to prevent the risk of them becoming pregnant, of which 80% were forced to accept the form of contraception that they were prescribed by the health workers. If the contraception were to fail or not be used then a non- government sanctioned birth could be aborted throughout the pregnancy and regardless of the mothers’ wishes.
Social implications, apart from the obvious degrading abuse of female’s human rights have led to the maternal mortality rate double in the same regions between those mothers who were having a sanctioned birth and those who were forced to give birth in secret at home without any trained medical assistance. The sex ratio is significantly skewed as the proportion of male to female births rose from 1.06 in 1979 at the beginning of the enhanced policy to 1.17 in 2001. (Hesketh, 2005). This is evidence of sex selective abortions and infanticide as couples are so desperate for a male child to carry on the family blood line, look after them in their parents in old age, and work on the family land.
When a couple have had a male son there is then the chance that he will never marry, as there is an estimated 8.5million surplus males in China. The males than don’t become married are usually the uneducated and poorer males that haven’t found a wife due to the competition and so there is a higher chance that they will engage in illegal sexual activity with female sex workers. This is dangerous as there is a higher risk that HIV and AIDS could be caught and transmitted, (Tucker et al, 2005).
In an attempt to beat the ban there was one loophole in the policy as multiple births were still allowed to take place and so many couples especially in rural areas, including Niu Jian Fang and Jiao Na from Henan province in rural central China, took fertility increasing drugs that increase the likelihood of a multiple births. This means that although there would still be a high probability of being sterilised once the pregnancy had finished the couple should be able to avoid the fine that is levied on couples with multiple pregnancies. (Reynold 2007).
Resistance to the policy is still common as the richer couples that are now in urban China have become increasingly willing to pay the fine for the second child so that they may have multiple children. This attempted resistance also includes giving birth in Hong Kong, where over half of births are now to main land Chinese citizens that want their children to enjoy the relative freedoms and avoid heavy fines. This however is putting a strain on the resources of the Hong Kong health service and so is attempting to be banned unless the father of the baby has Hong Kong citizenship already. (BBC, 2012).
These may be just a few of the short term issues but there are still long term issues to come in China as they currently have a large economically active population, that will one day retire. When this happens the dependency ratio may place a huge economic burden on the 15-65 year olds who are still in the labour market, as the proportion of elderly people in the population increases. In China internal and external migration affects how an elderly person is cared for especially in rural areas where many of the elderly’s children move away to the urban areas in search of better jobs. As population is closely linked to economic development, which China has done quite rapidly China will be one of the key countries hit by the phenomenon which will see 80% of the world’s ageing population living in developing regions by 2050. This will inevitably lead to a change in the health priorities as solutions will have to be found including state help to avoid elderly people sinking into absolute poverty and primary healthcare developments to deal with new types of care needed through degeneration, (WHO, 2012).
China may have a chequered past but there have been some positive outcomes in that the population is not far off the 1.2billion population aim that was hoped for at 1.27billion and China has become one of the largest economies in the world. Even though the size of China’s economy is vast this divided by the size of the population to give GDP per capita is one of the reasons China is still classed as a developing nation, as classed by their own embassy in 2010. (Embassy of the People’s Republic of China in the United States)
Attane, I (2002) China’s Family Planning Policy: An Overview of its Past and Future. Studies in Family Planning 33(1): 103-113
BBC, (2012) Hong Kong to limit mainland China maternity services, BBC
http://www.bbc.co.uk/news/world-asia-china-17838280 [accessed 05/02/13]
Embassy of the People’s Republic of China in the United States, (2010). China’s developing-country identity remains unchanged
http://www.china-embassy.org/eng/gdxw/t723893.htm [accessed 05/02/13]
Hesketh, T (2005) The Effect of China’s One Child Family Policy After 25 Years. New England Journal of Medicine 353: 1171-76
Reynolds. J, (2007). Chinese challenge one-child policy, BBC News, China
http://news.bbc.co.uk/1/hi/world/asia-pacific/6694135.stm [accessed 05/02/13]
Tucker. J, et al (2005) Surplus men, sex work, and the spread of HIV in China, Editorial Review, Lippincott Williams & Wilkins
World Health Organisation, (2012). About ageing and life-course.
http://www.who.int/ageing/about/ageing_life_course/en/ [accessed 05/02/13]