Sep.15th.2005

China's one-child family policy has had a great effect on the lives of nearly a quarter of the world's population for a quarter of a century. When the policy was introduced in 1979, the Chinese government claimed that it was a short-term measure and that the goal was to move toward a voluntary small-family culture.1 In this article, we examine to what extent this goal has been achieved and the implications for the future of the policy. First we explain why the policy was introduced and how it is now implemented. We also examine the consequences of the policy in regard to population growth, the ratio between men and women, and the ratio between adult children and dependent elderly parents. Finally, we examine the relevance of the policy in contemporary China and whether the time has come for the policy to be relaxed.

Background

In 1979, the Chinese government embarked on an ambitious program of market reform following the economic stagnation of the Cultural Revolution. At the time, China was home to a quarter of the world's people, who were occupying just 7 percent of world's arable land. Two thirds of the population were under the age of 30 years, and the baby boomers of the 1950s and 1960s were entering their reproductive years. The government saw strict population containment as essential to economic reform and to an improvement in living standards.2 So the one-child family policy was introduced.

The policy consists of a set of regulations governing the approved size of Chinese families. These regulations include restrictions on family size, late marriage and childbearing, and the spacing of children (in cases in which second children are permitted). The State Family Planning Bureau sets the overall targets and policy direction. Family-planning committees at provincial and county levels devise local strategies for implementation. Despite its name, the one-child rule applies to a minority of the population; for urban residents and government employees, the policy is strictly enforced, with few exceptions. The exceptions include families in which the first child has a disability or both parents work in high-risk occupations (such as mining) or are themselves from one-child families (in some areas).

In rural areas, where approximately 70 percent of the people live, a second child is generally allowed after five years, but this provision sometimes applies only if the first child is a girl — a clear acknowledgment of the traditional preference for boys.3 A third child is allowed among some ethnic minorities and in remote, underpopulated areas. The policy is underpinned by a system of rewards and penalties, which are largely meted out at the discretion of local officials and hence vary widely. They include economic incentives for compliance and substantial fines, confiscation of belongings, and dismissal from work for noncompliance.

The policy depends on virtually universal access to contraception and abortion. A total of 87 percent of all married women use contraception4; this statistic compares with about one third in most developing countries.5 There is heavy reliance on long-term contraception, with intrauterine devices and sterilizations together accounting for more than 90 percent of contraceptive methods used since the mid-1980s.4,6 The number of sterilizations has declined since the peak in the early 1990s (Table 1). For the majority of women, no choice in contraception is offered; 80 percent of women in a recent large study said they had no choice and just accepted the method recommended by the family-planning worker.4 The use of these long-term methods keeps abortion rates relatively low, with 25 percent of women of reproductive age having had at least one abortion, as compared with 43 percent in the United States.7 The main reasons given for abortion are contraceptive failure and a lack of government approval for the pregnancy under the one-child policy.8 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