But there are some indications that the traditional preference for boys may be shifting. In the National Family Planning and Reproductive Health Survey, 37 percent of women (predominantly young, urban women) claimed to have no preference for one sex over the other, whereas 45 percent said the ideal family consisted of one boy and one girl. In fact, slightly more women expressed a preference for one girl (5.9 percent) than for one boy (5.6 percent).29 Although these expressed preferences have not yet been translated into a normalization of the sex ratio, this may happen in the near future.
Ratio of Old-age Dependency
The rapid decrease in the birth rate, combined with stable or improving life expectancy, has led to an increasing proportion of elderly people and an increase in the ratio between elderly parents and adult children.30 In China, the percentage of the population over the age of 65 years was 5 percent in 1982 and now stands at 7.5 percent but is expected to rise to more than 15 percent by 2025.28 Although these figures are lower than those in most industrialized countries (especially Japan, where the proportion of people over the age of 65 years is 20 percent), a lack of adequate pension coverage in China means that financial dependence on offspring is still necessary for approximately 70 percent of elderly people.31 Pension coverage is available only to those employed in the government sector and large companies. In China, this problem has been named the "4:2:1" phenomenon, meaning that increasing numbers of couples will be solely responsible for the care of one child and four parents.
Initiatives are under way to improve access to government pensions and to encourage saving for private pensions in an attempt to reduce the burden of the 4:2:1 phenomenon.7 In addition, a specific measure has been introduced to address the problem: in urban areas, couples who are themselves both only children are allowed to have more than one child. As only children reach reproductive age, many couples will meet these criteria, though how many will take advantage of the opportunity to have more than one child remains to be seen.
The Future of the Policy
The Chinese government is facing an important challenge: the need to balance the basic human right of reproduction with population growth, which, despite the policy's success, is still increasing at a rate of 8 per 1000, or 10 million people, per year (equivalent to the population of Belgium). In making decisions about the future, several factors must be taken into consideration.
First, relaxation of the policy can be considered only if fertility aspirations are such that a baby boom will not result. There is now good evidence that China is becoming a small-family culture. Data from the National Family Planning and Reproductive Health Survey show that 35 percent of the women questioned preferred having only one child and 57 percent preferred having two children, but very few women (an average of 5.8 percent) wanted more than two29 (Table 3). Young, urban, educated women wanted fewer children than did their counterparts in rural areas. In other studies, 75 percent of respondents in wealthy Jiangsu province were satisfied with their one child regardless of sex, whereas in poorer Yunnan province, 55 percent were satisfied with an only boy, but only 30 percent were satisfied with an only girl.8 And in Tibet, where most couples are permitted to have three children, 65 percent of the women wanted only one or two children.32 However, the survey also showed that in urban areas of China, where (with very few exceptions) only one child is allowed, 43 percent of women still preferred having two, so the one-child restriction remains unacceptable for nearly half of urban Chinese women.
Second, what was appropriate in 1979 may not be so now. China has undergone massive socioeconomic change during the past 25 years. With the freedoms that have resulted from wealth and globalization, the one-child policy seems increasingly anachronistic. Increased wealth and freedom also make it harder for the government to enforce the policy. Economic disincentives are not a deterrent to many wealthy people, and increased freedom of movement has made it difficult for family-planning authorities to track down people if they choose to flout the regulations.
Finally, the evidence of slowing population growth, the high sex ratio, the increasing number of elderly people, and the risks associated with avoidance of medical care by women with unapproved pregnancies suggest that a relaxation of the one-child policy would be desirable.
Several options for the future have been suggested. One possibility is that everyone could be allowed to have up to two children, with a space of at least five years between them.1 It has been predicted that this option would yield a total fertility rate of 1.7 during the next two decades, which would help to normalize the sex ratio, reduce the 4:2:1 phenomenon, and be acceptable to the majority of people.
But the government feels that vigilance is still essential. It is feared that any wavering in implementation of the policy may compromise the goal of keeping the population below 1.4 billion by 2010, which in turn could threaten economic growth and stability. There are particular concerns about the increasing level of migration from rural to urban areas, which has fueled substantial urban growth.
Therefore, in 2002 it was announced that there would be no fundamental policy changes but that certain aspects of policy implementation would be relaxed.33 For example, couples are to be allowed choice in contraceptive methods as part of so-called client-centered family-planning services. These changes have now been introduced in 800 counties (out of a total of 3000), and more are planned. Furthermore, couples no longer need to obtain permission to have a first child, a move that spells the end of the very unpopular system of local birth quotas, which meant that couples were forced to delay pregnancy if the local quota was exceeded. These changes, together with declining fertility aspirations, have reduced (though not eliminated) the tensions associated with the government's efforts to control population growth and have allowed the government to adopt a cautious and gradual approach to relaxing the one-child policy.
Source Information
From the Center for International Child Health, Institute of Child Health, University College London (T.H.); the Institute of Social and Family Medicine, Zhejiang University, Hangzhou, China (L.L.); and the Institute of Public Health, Zhejiang Normal University, Jinhua, China (Z.W.X.).