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cbt%B9%A4%B3%A7+%C1%D0%B1%ED+%D1%C7%D6%DE%C6%EF%B1%F8 usearchdbt%B9%A4%B3%A7+%C1%D0%B1%ED+%D1%C7%D6%DE%C6%EF%B1%F8r Friends h searchn Brides -c Single i Service dsearchp Index l Sex cysearch8 Women who proceed with an unapproved pregnancy are known to be reluctant to use antenatal and obstetric services because they fear they will face pressure to have an abortion or fines for violating the one-child policy.9,10 Many deliveries of babies that have not been officially sanctioned occur at home without trained personnel, a practice that is associated with the risk of maternal or neonatal mortality. A study carried out in rural Sichuan province in 1990 reported a doubling of maternal deaths for unapproved pregnancies as compared with those receiving government sanction.11 Population Growth
When the one-child policy was introduced, the government set a target population of 1.2 billion by the year 2000. The census of 2000 put the population at 1.27 billion,12 although some demographers regard this number as an underestimate.13 The collection of population statistics in China is known to be subject to manipulation to conform with family-planning regulations, since the process is overseen by officials who are often unwilling to uncover any violations of the rules.14,15 Chinese authorities claim that the policy has prevented 250 to 300 million births. The total fertility rate, which is defined as the mean number of children born per woman, decreased from 2.9 in 1979 to 1.7 in 2004, with a rate of 1.3 in urban areas and just under 2.0 in rural areas.16 This trend has created a distinct demographic pattern of urban families with predominantly one child and rural families with predominantly two children.
However, the policy itself is probably only partially responsible for the reduction in the total fertility rate. The most dramatic decrease in the rate actually occurred before the policy was imposed (Figure 1). Between 1970 and 1979, the largely voluntary "late, long, few" policy, which called for later childbearing, greater spacing between children, and fewer children, had already resulted in a halving of the total fertility rate, from 5.9 to 2.9.3 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.16 In addition, many countries have had substantial declines in fertility during the past 25 years, and China's neighbors in East Asia have some of the lowest total fertility rates in the world: 1.04 in Singapore, 1.38 in Japan, and 0.91 in the Hong Kong Special Administrative Region.17 Even allowing for the fact that these countries are more developed and urbanized than China, the parallels are hard to ignore. 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.
The Sex Ratio
The effect of the policy on the sex ratio has received much attention. The sex ratio at birth, defined as the proportion of male live births to female live births, ranges from 1.03 to 1.07 in industrialized countries.18 Since the onset of the one-child policy, there has been a steady increase in the reported sex ratio, from 1.06 in 1979, to 1.11 in 1988, to 1.17 in 2001.19 There are marked and well-documented local differences, with ratios of up to 1.3 in rural Anhui, Guangdong, and Qinghai provinces. Data from the 2001 National Family Planning and Reproductive Health Survey, which was carried out among a nationally representative sample of 39,600 women of reproductive age and is the most recent large-scale survey of reproductive health and fertility, show clearly that the increased sex ratio is not confined predominantly to rural China,19 as has been previously assumed20 (Table 2). There is a marked gradient across birth order: in rural areas, the sex ratio for the first birth is 1.05 (within normal limits), but it rises steeply with birth order. In urban areas, the sex ratio is 1.13 for the first birth and peaks at 1.30 for the second birth but decreases for the third and fourth births (which are rare in urban areas). The picture that emerges is that some urban Chinese make the choice to perform sex selection with the first pregnancy, since they are allowed only one child. In rural areas, most couples are permitted to have a second child, especially if the first is female. So if the second (or subsequent) child is female, the pregnancy often "disappears," allowing the couple to have another child in an attempt to have a son.
What happens to all the missing girls is a matter of speculation. Sex-selective abortion after ultrasonography undoubtedly accounts for a large proportion of the decline in female births.20,21 Actual figures are impossible to obtain, because sex-selective abortion is illegal but is known to be widely carried out, helped by a burgeoning private sector. Nonregistration of female births also contributes to the sex-ratio gap.14,15 A 1995 household survey carried out in three provinces found a normal sex ratio in the under-14 age group, with the actual number of girls exceeding the number registered by 22 percent.22 Although infanticide of girls is probably very rare now, less aggressive treatment of sick female infants is known to occur.23
The Chinese government has acknowledged the potentially disastrous social consequences of this sex imbalance. The shortage of women may have increased mental health problems and socially disruptive behavior among men and has left some men unable to marry and have a family.24 The scarcity of females has resulted in kidnapping and trafficking of women for marriage and increased numbers of commercial sex workers, with a potential resultant rise in human immunodeficiency virus infection and other sexually transmitted diseases.25 There are fears that these consequences could be a real threat to China's stability in the future.26
Although the one-child policy has been blamed for the high sex ratio, it is probably just one contributory factor. There was a high sex ratio in China in the 1930s and 1940s, mostly resulting from infanticide of girls, and then the ratio declined in the years after the Communist Revolution of 1949.27 Many other Asian countries with declining fertility rates and a traditional preference for males are also seeing sex-ratio imbalances ¡ª Taiwan, 1.19; Singapore, 1.18; South Korea, 1.12; and parts of northern India, 1.2028 ¡ª largely because of sex-selective abortion.27 In China, the marked increase in the sex ratio between the 1980s and 1990s coincided with much easier access to cheap ultrasonography and not with any substantial change in enforcement of the one-child policy. It is likely, therefore, that even in the absence of the policy, sex-selective abortion would continue, although it would probably be less common. The solution will come only with a change in attitudes toward female offspring. Publicity campaigns promoting girls are now widespread and acknowledge the importance of such change (Figure 2).
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.