The One Child Family Policy

hat is known as the One Child

Policy was introduced in 1979

as a set of rules and regulations

governing the approved size of Chinese

families. This was not the ﬁrst attempt

by China to curb the growth of its popu-

lation. The so called “late, long, few”

policy was introduced in the early 1970,

because the population had risen dra-

matically during the 1950s and 60s, from

540 million in 1950 to 850 million in

1970. The “late, long, few” policy was a

conventional family planning pro-

gramme, consisting of the encourage-

ment of later child bearing, longer spac-

ing, and fewer children. This policy led to

a fall in the total fertility rate (TFR) from

5.9 in 1970 to 2.7 in 1979.

But this fall

was not enough for Deng Xiao Ping who

at this time was setting out his economic

refor m programme. Projections showed

that the population would continue to

rise sharply, because around two thirds

of the population were under 30, and

because the baby boomers of the 1950s

and 60s were entering their reproductive

years. Deng saw population containment

as essential to the success of his eco-

nomic reform prog ramme.

So the One

Child Policy was introduced. Twenty

three years later the TFR is estimated to

be 1.8, and it has remained unchanged

for the past ﬁve years.

There is much confusion about the

policy, mainly because in this vast country

the way in which the policy is actually

implemented varies considerab ly from

place to place.

For example, families of

four and more are still tolerated (though

not ofﬁcially allow ed) in some remote

rural areas, while a strict one child per

family policy is imposed in the cities.

There is a central policy making body, the

State Family Planning Committee, which

is a separate and pow erful government

department. This bureau sets targets and

provides guidelines on implementation,

but it is the family planning committees

at provincial level w ho make decisions

about actual implementation. The impos-

ing of penalties is usually left to local cad-

res. This explains the wide variation in

practice.

In Chinese cities only one child is

allowed with a few exceptions: ﬁrstly, in

the case of second marriage where one

partner has not had a child; secondly, if

the ﬁrst child has an abnormality or a

condition which will reduce life expect-

ancy (there is a list of such conditions

and a doctor is required to provide the

necessary proof); thirdly, if the father is

in a dangerous occupation, such as min-

ing; and fourthly, where both spouses are

only children. This latter is important,

since the ﬁrst cohort of only children are

now reaching their reproductive years

and more and more couples will fulﬁl

this requirement.

But the policy is more relaxed in the

countryside where around 70% of the

population live. Here, with the exception

of government workers, two children are

per mitted, if the ﬁrst is a girl, and

provided there is a four year gap. This

clearly acknowledges the traditional

preference for boys, which is still the

case, particularly in rural areas. Third

children are allowed for some minority

ethnic groups.

“The whole programme is

underpinned by a massive health

education campaign”

Late marriage and spacing still play an

important role. Marriage is not permit-

ted until age 25 for men and 23 for

women in cities, ages 23 and 21 respec-

tively in rural areas. The whole pro-

gramme is underpinned by a massive

health education campaign: the mes-

sages tend to focus on the societal

dangers of overpopulation and the per-

sonal material beneﬁts of having only

one child.

Modes of enforcement and penalties

vary widely. In m any rural areas ﬂouting

of the regulations is not rare. It is

difﬁcult for local cadres to enforce

unpopular regulations in their own small

communities. If a woman becomes preg-

nant outside the policy there is pressure

to have an abortion. Nowadays there is

considerable acceptance of this in the

cities, at least. If an “illegal” pregnancy is

car ried to term, there is a range of penal-

ties for failure to comply. If the parents

are government workers or employed by

state owned enterprises this will mean

loss of employment. But for the majority

the punishment includes ﬁnes, loss of

beneﬁts for the ﬁrst child, and higher

charges for obstetric care.

In extreme

cases women who become pregnant out-

side the policy may leave their home-

towns to deliver elsewhere, in a place

they are not known. The new mobility of

the r ural workforce has made such

evasion of the authorities much easier.

In the West there has been much criti-

cism of the Policy as a violation of the

human right to reproduce. Even the Chi-

nese Government would agree that

denying individuals the right to have as

many children as they want is not desir-

able. But the Policy is seen as a necessity

in the short term. In particular, in recent

years the Government sees that restric-

tion of family size is fundamental to its

ongoing poverty alleviation programme:

to break the vicious cycle of poverty

leading to more children, which in turn

generates more poverty.

Apart from curbing population growth,

the policy has had a number of beneﬁcial

effects. Women hav e access to contracep-

tion and safe legal abortion. Mothers are

freed from the burden of many pregnan-

cies with the associated morbidity and

mortality. They also have more freedom to

work outside the home, acquire skills, and

contribute to the household income, with

resulting beneﬁts in terms of independ-

ence and self esteem. Children beneﬁt

from the increased resources devoted to

them.

Only daughters may particularly

beneﬁt from not having to compete for

resources with sons.

“The policy has contributed to

gender imbalance in rural areas”

But there is of course a negative side.

The policy has contributed to gender

imbalance in rural areas, with an excess

of male births reported in some

areas.

10–12

The 1995 population survey

reported average male:female ratios of

108:100 in rural areas.

But this is not

just because of sex selective abortion

(which is now illegal,

though undoubt-

edly still occurs), but also because of

failure to report female births. Female

infanticide is probably extremely rare

now. When the Policy was introduced

there were concerns about support for

the elderly.

In urban areas around 70%

of the population have some form of

pension, but in rural areas care and sup-

port for the elderly remains the responsi-

bility of offspring. With small families

care for the elderly becomes a consider-

able burden.

Finally, there is the issue of the health

and psychological effects of being an

only child. This is the question asked by

Hesketh et al in this issue.

Much has

been made of the over indulged Little

Emperors of contemporary China,

but

there is little hard evidence that they are

any more spoilt than their contemporar-

ies in other part of East Asia or even the

West.

8918

Over the past generation dis-

posable incomes have increased for the

China

...................................................................................

The One Child Family Policy

W X Zhu

...................................................................................

The government hopes that there will be a shift towards the

“small family culture”

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463

www.archdischild.com

majority, and combined with greater

access to goods and commodities and

freedom to travel, this means that for

many children there are huge opportuni-

ties, irrespective of the family size. One

of the problems with any research in this

area is that it is likely to be confounded

by socioeconomic differences, given that

those couples who are allowed to have

more than one child are generally from

lower income and education groups. This

is why Hesketh et al’s analysis of only and

sibling children in one wealthy county is

particularly welcome. After controlling

for potential confounders they found

very small differences between sibling

families and one child families and con-

cluded that being an only child may

actually confer some beneﬁts.

It was never intended that the Policy

would last forever.

The Chinese gov ern-

ment has achieved fairly widespread

acceptance for a strict family limitation

policy.

How ever, increasing wealth and

employment freedom mean that commu-

nal pressure and economic disincentives

will not be enough to contain the popula-

tion in the future. The government hopes

that there will be a shift towards the

“small family culture” underpinned by

improv ed living standards, guaranteed

survival of children, and security in old

age.

(It is interesting to note that the

small family culture is the norm in Hong

Kong where the policy is not in force and

the TFR is just 1.1.

) There is evidence that

there is growing acceptance of small

families in China,

20 21

so much so that in

30 pilot counties the policy has been

lifted, allowing couples to choose their

family size.

A possible scenario for the

future is allowing all couples to have two

children, with a ﬁve y ear gap in both

urban and rural areas.

This would be

more popular and would be perceived as

fairer. Research like that by Hesketh et al,

which suggests that the One Child Policy

may not do harm to children and adoles-

cents, should help to allay some of the

fears held by opponents of the policy.

Arch Dis Child

2003;88:463–464

.....................

Author’s affiliation

W X Zhu, Health Unlimited, East Asia

Correspondence to: Dr W X Zhu, Apt 2-401 Ya

shi Yuan, 39 NanZhong Guo Xin Chen, 149

Wen Hua Road, Hangzhou, Zh 210012,

China; [email protected]

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A chinese couple with one child in a yin-yang posture representing male-female balance.

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464

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