The Hindu Business Line : China's one-child norm

It was a mammoth task for the Chinese government to implement the one-child norm in rural China, where literacy was low, and superstitions high. The urban couple preferred having a single child, for it fitted in well with their double income, nuclear family establishment. However, the rural family unit, which would have preferred having more working hands, reconciled to the guideline, largely because of stringent checks, punishment to those violating the norm and, more importantly, added financial benefits and other allowances for those adhering to it.

There was also a general reluctance to tamper with `nature' among the rural population. The women considered talking freely of sex or protection as "dirty" or "filthy". Many resisted insertion of foreign bodies such as IUDs and abortions were considered a sure way of getting "weak".

Chinese women are vulnerable to several health problems with women in rural areas facing a far higher risk of HIV infection and genital infections. For women residing in outlying mountainous and poor regions, the incidence and vulnerability to reproductive ailments are alarmingly high.

Says Chen Zheojun, Director of the Family Planning Association of China, "It was common practice for most women to conceal disease for fear of being mocked at." But official intervention and sustained awareness campaigns, made it clear that there was no way out. This steely approach was balanced with financial aid, counselling and free medication which addressed every single issue of the target audience.

Provincial governments set up city-specific helplines on toll-free numbers which allowed women to seek professional advice on private matters, even while retaining their anonymity. Women started feeling comfortable about discussing issues with their doctors, and also realised that multiple pregnancies and lack of protection was causing infections and related problems, and hence started co-operating.

The results of this saw fertility in China declining dramatically over the last three decades. In 1979, China implemented a policy advocating one child per couple, with some exceptions in rural areas for couples having only a daughter.

A comprehensive action plan

In 1994, an action programme was approved by the International Conference on Population and Development in Cairo, elaborating the vital importance of health services for women and linking this to women's contribution to the sustained development of any society. Since then, China has redoubled its efforts and launched pilot service centres in more than 800 counties across the country, covering approximately 33 per cent of the country's total population. A range of technical services are provided to help women choose contraceptive methods, take prompt measures to guard against disease and offer better care for babies. Thanks to guidance from experts and more open discussions on reproductive healthcare, many women have changed their attitude towards sex.

In Shangrao City, Jiangxi, hospitals offer preferential care to rural women, including free infrared treatment and a 50 per cent discount on service charges. The Chinese government made every effort to popularise knowledge on women's reproductive health, contraception and baby care since its adoption of a family planning policy about 20 years ago. The response has been overwhelming. What the government has succeeded in doing is to gain the trust of women.

A study, conducted by the China Population Information and Research Centre (CPIRC) in collaboration with the Women's Studies Project at Family Health International, examined the effects of family planning on different generations of Chinese women. South Jiangsu, which is an east coast province with a booming economy and a strong family planning programme, experienced a rapid fertility decline. North Anhui, a province in middle China, has an agrarian economy where the family planning programme was relatively less effective.

The common features in both provinces were similar to our own Indian rural mindset where sons were preferred and once preliminary examination revealed a girl child, abortion was resorted to.

However, in some cases, couples wanted daughters because they were easier to raise, less expensive to provide for, and far nicer to their parents in old age. Some South Jiangsu couples also saw them as an economic benefit, since their embroidery skills added to the family income.

Chinese health officials went beyond just providing condoms to different segments and insisting that women enforce family planning interventions once the first child was born. They expanded the range of reproductive health services for women who were beyond childbearing age to include young adults, older women and men. They promoted non-economic benefits of family planning such as improved quality of life for families. They made available contraceptive methods, which included not just IUDs and female sterilisation but also newer, more effective IUDs, more short-term methods and vasectomy.

Providing family planning counselling to post-abortion women on how to prevent contraceptive failures in the future was also well received. They updated training on reproductive health services for service providers in addition to promoting the value of daughters, through collaborative efforts by policy-makers, providers and community members.

A CPIRC representative cited the need to implement service-oriented approaches and improve women's status. The link between women's economic and educational opportunities and a reduced birth rate was acknowledged.

This is not to say that the aggressive and sustained family planning initiatives of the Chinese government did not have their share of negative fallout, though in the long term these are negligible and can be addressed. Repeated abortions led to complications in women's reproductive health; another disturbing urban trend in China has been the preference of a Caesarean section. But over the years, the single child norm has become a way of life for the Chinese.

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