Monday, September 19, 2005

NEJM addresses China's one-child policy

Every once in a while, the New England Journal of Medicine offers free access to an article, which is always an opportunity I appreciate being a starving college graduate who can never get my hands on the paper copies (those lucky students!). This month, they offered more articles than usual, and among them was an article addressing a highly controversial and rarely discussed topic: the government-enforced one-child policy in China. A second article, also offered free of charge, addresses the evolving healthcare system in China. I am only going to address the former in this post.

First, the article gives a little background on the "birth regulation policy" that was formally developed in 1979 to curb births among the "baby boomers." Between 1970 and 1979, it was highly recommended that a couple follow the "late, long, few" advice. This advice suggested that a woman wait for her first child, leave many years between children, and to have only bear one or two children. This mentality cut the birth rate in half in just 10 years, from 5.9 to 2.9, however "after the one-child policy was introduced, there was a more gradual fall in the rate until 1995, and it has more or less stabilized at approximately 1.7 since then."

The authors of the article speculate that "the policy itself is probably only partially responsible for the reduction in the total fertility rate… It is reasonable to speculate that there would have been a further decline in China's total fertility rate had the voluntary policy of the 1970s continued." I highly doubt this fact. When forcibly dictting the lives of married couples, they tend to desire to rebel. Social or cultural influence cannot universally convince all couples that having one child is desirable; brainwashing and moral dictatorship can.

This information given in the study is helpful in providing a foundation for studying the issue, however I am deeply concerned with some of the data and conclusions that are given in the article. There was strict application of this policy, which in most regions meant that only one child was permitted. In rural areas, there were exceptions, such as if the first child was a girl, a second child would be permitted (in hopes of bearing a boy "to continue the family line").

The authors rightly admit that "the policy depends on virtually universal access to contraception and abortion," citing a whopping 87% usage rate of contraceptives. On the other hand, they fail to give proper "credit" to the forced implementation of the policy.

Heavy reliance was given to the long-term contraceptive measures of sterilization and IUD insertion. However, even with the forced use of certain contraceptives, somehow, 13% get away with no use of contraception. This assumes that this 13% is naturally sterile, abstinent or desiring pregnancy. Because pregnancy is only allowed once in most cases, the idea that women are not using contraception because they attempt pregnancy is also unlikely. These discrepancies open the door for non-sanctioned pregnancies which result in coerced or forced abortions. It is not likely that these forced abortions are properly documented nor included in statistics.

Of course, these declining birth rates have created a problem that is also seen in the United States: not enough young people to care for the elderly. In the United States the birth rate is at 2.08 which is not much higher than China. The Social Security program is going bankrupt simply because there are not enough young people paying into the system. This has been brought about by the decline in the cultural acceptance of children, and thus the lowered birth rate. In the US, China and around the world, this phenomenon opens wide the door to euthanasia.

Steven Mosher of the Population Research Institute was the first American social scientist to travel to China to study this policy. The year was 1980, and to his horror, he witnessed forced abortions and sterilizations, coercion and dictation in the area of childbearing (a couple was required to obtain permission before achieving pregnancy) and other human rights abuses. He wrote a first-hand story of "Chi An" in A Mother's Ordeal.

The story told therein was the beginning of the United States policy to grant asylum to women escaping their own country for reasons having to do with the birth of a child. This policy was established by the first President Bush, who also removed US assistance of the United Nations Population Fund (UNFPA) because of its support of sterilization and abortion. Though revoked under Clinton, this became policy again under the second President Bush. In fact, a report today gives details of over $30 million that President Bush withheld from the UNFPA this year.

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