Behind the Great Wall: China's population policies.

IN THE EARLY 1970s, WHEN CHINA WAS MORE THAN TWO decades into its communist experiment, its leaders took stock of the country's soaring population and concluded that they were headed for disaster. Between 1962 and 1972 alone, the country had added 300 million people to a national population moving rapidly toward the 1 billion mark. These new arrivals were living longer, straining arable land, social services and the national economy.

The result, as everyone now knows, was a population-control policy breathtaking in its scope and ruthlessness.

A quarter of a century later, Chinese policies and practices have begun to change remarkably as coercive methods are rejected--though certainly not everywhere in the country--and the official goal has become a more client-centered approach to family planning. Women are becoming more influential as both directors and recipients of services, which the Chinese are slowly expanding into a broader reproductive health program. Furthermore, as the country begins to face up to the potentially horrific toll that AID S could take in coming decades, once-suppressed issues--frank sex education, the needs of the young involved in premarital sex and the need for a woman's right to protected sex--are being discussed more openly and urgently.

On September 1, 2002, a new law went into effect that called for recognizing "people's rights and interests." China, however, continues to live with the legacy of its most totalitarian population-control experiments, complicating its relations with other governments and international aid organizations willing to help Chinese family planners.

ONE-CHILD POLICY 

Although a one-child-per-couple goal was announced in 1979, it was not until 1983 that the one-child policy was codified by the government. The law had three main points: A woman who had produced her one allowable child was to have an intrauterine device inserted to prevent further births. Any couple with more than one child was required to have one partner sterilized; it was usually the mother. Any woman pregnant outside the rules without official permission could be forced to have an abortion. Only in certain areas, mostly rural and with minority-group populations, were parents permitted more than one child.

So harsh was the effect of these orders that within a year the government was apparently trying to temper them, warning against excessive coercion. Outside experts, noting both the apparent problems the excessively rigid policy was causing--including outright defiance by many Chinese--and the confusion that came of halfhearted measures to soften the law, saw a period of drift in the mid-1980s. But new crackdowns occurred in 1986 and 1991.

Meanwhile, the Chinese government had also begun to regulate the age of marriage as another method of cutting births. A 1980 law forbade marriage before the age of 22 for men and 20 for women. That law, still on the books, seems to have had mixed success, given that in 1988 a "Circular on Earnestly Implementing the Marriage Law and Strictly Prohibiting Marriage in Violation of the Law" was making the rounds of local and provincial offices. Widely-criticized economic incentives and disincentives to reward single-child families or punish those who had more than one birth still exist.

Moreover, an Australian human rights delegation to China reported in 1993, several Chinese provinces were requiring people with mental illnesses or handicaps to be sterilized, despite a national government decision not to enforce a law demanding that people with handicaps or hereditary diseases postpone marriage or have no children if they did marry. These efforts brought an already controversial population policy into the realm of eugenics and serious social engineering.

THE IMPACT OF CAIRO

By the turn of this century, however, significant steps toward a more voluntary, less coercive and quota-driven approach to family planning had reduced abortions of all kinds--by about 38 percent in the last four years alone, according to United Nations experts. The turn toward a more voluntary family planning program was related to the UN's 1994 International Conference on Population and Development, held in Cairo. That watershed meeting put women's control over their reproductive health at the center of any population agenda. China took that into account in rethinking its programs.

In China, the new thinking was made public in a 1994 government document, "Guidelines on Family Planning Work in China, 1995-2000," which went into effect in a limited number of areas the following year, with hundreds of other localities added since. In taking these steps, China's State Family Planning Commission has had the help of the Ford Foundation and the Population Council, both based in New York, as well as the University of Michigan and several international agencies.

In April 2002, a group of British members of parliament (MPs) representing the three major political parties went to China to study its population programs and concluded, "The one-child policy is disintegrating rapidly, and for a variety of reasons." They said that since ethnic minorities have always been excluded from the rule and couples who are from single-child families themselves are now also permitted more than one child of their own, far fewer people must follow the restriction, though many other couples were still subject to deterrent fines in some areas if they had more than one or two births.

The visiting MPs were told that more young people were deciding on their own not to have children at all, or would voluntarily opt for no more than one or two, often for economic reasons. Demographers sense that two is rapidly becoming the ideal norm. In June 2002, the journal China Population Today-reported the results of a surveyin Zhejiang province testing attitudes about family size and found that if they were told to take into account "the interests of the state and society," less than half a percent of people questioned said they wanted no children; 43.7 percent wanted one and 54.4 percent would have two. When asked the question again but told they could make a completely free choice with no restrictions, nearly 62 percent chose two, and some dared to say they would have five or more.

According to the United Nations Population Fund (UNFPA), there are still strong advocates in China of not letting go of more compulsory policies, for fear that the considerable gains of the last two decades could be reversed. Statistics are still alarming: China has one-fifth of the world's people on only seven percent of the planet's arable land.

In the mid-1990s, when the United States congress was discussing, and ultimately passing, legislation allowing would be immigrants to seek asylum in the US because of one-child policies in their homelands, an exhaustive study of the complications and contradictions of Chinese practices drawn from a range of experts' work was produced by the Department of Justice's Immigration and Naturalization Resource Information Center. Released in March 1995, the report, "Family Planning Policy and Practice in the People's Republic of China," noted, among other observations, that while there was no doubt that tough policies were a major factor in fertility decline, so was socioeconomic development, which in turn was not unrelated to smaller family size.

A POSITIVE OUTCOME?

There is no denying that there have been some dramatic, long-term positive effects of China's population policies--however initially draconian they were or how much they continue to abuse women's rights. These are very clearly revealed when the demography of the world's most populous nation is compared with that of India, the second-most-populous country. In 1950, the United Nations population division recorded a Chinese population of almost 555 million. India's population was then 357 million. By 2000, when China's population had slightly more than doubled to just over 1.2 billion, India's had nearly tripled to reach the 1 billion mark. India is expected to overtake China as the world's most populous nation in the next four or five decades.

China's population is now growing at 0.71 percent annually. India's rate of growth is 1.52 percent. Fertility--the number of children born to each woman--has dropped to 1.8 in China. In India the figure is 3.3. (The universal replacement fertility level--that is, one child to replace each parent, with a fraction added to account for unexpected deaths--is set by demographers at 2.1.) Indians, who had only a brief brush with harsh population policies in the 1970s under a program run by Prime Minister Indira Gandhi's son Sanjay, argue justifiably that they have made large strides also, and if on paper they are not so impressive as China's, they were achieved without repression and grim punishments.

Still, in human terms, there are enough diverging numbers that can be linked to the social benefits of China's sharply reduced population growth and India's slower progress. Infant mortality in China, according to United Nations figures, is 36.5 deaths in every 1,000 births. In India, there are 64.7 deaths per 1,000 births. Life expectancy in China now stands at 71 years; in India it is 64.

Large numbers in a poor country put great strain on a family's resources as well as a nation's. In India, nearly a quarter of the population is undernourished, with nearly half the children under five already underweight and undersized. In China, United Nations figures show a national malnutrition rate of nine percent, with about 10 percent of children underweight and 17 percent undersized. Chinese children are immunized at a much higher rate than Indian children.

Fewer children can free women for work and mean that families can send girls as well as boys to school. The 2002 United Nations Human Development Report showed that about 45 percent of women (and 64 percent of women aged 15-24) are literate in India compared with 76 percent of women (and 96 percent aged 1524) in China. Just less than nine percent of India's parliamentary seats are held by women; in China the figure is 22 percent. In India 42 percent of women are involved in economic activity; in China nearly 73 percent are. Contraceptive prevalence is twice as high in China, where nine out of ten women are also attended at birth by health professionals--more than double the Indian rate.

DISTORTED RATIOS

In both China and India, however, there are more men than women, an indication consistent with sex-based abortions, female infanticide or the neglect of baby girls in favor of boys. A 2000 report by the United States Embassy in Beijing reported that Chinese studies acknowledge the imbalance in the male-to-female ratio at birth. The problem is particularly acute for second or third births.

"Ultrasound machines are widely (and illegally) used to facilitate sex-selective abortions in China," the report said. "Failure to report female births, systemic neglect of gift babies (gift babies have a higher mortality rate than boys in China) and to some extent infanticide are other factors, in addition to abortion, that Chinese demographers believe underpin the sex-ratio imbalance." China Population Today, an official publication, reported in its June 2002 issue that the 2000 national census had revealed an ever-growing gap. The country's sex ratio at birth was 117 boys to 100 girls. In 1990 the male-female ratio was 111:100. A normal level would be between 103:100 and 107:100, the journal said.

Obviously, the shortage of women is beginning to be felt acutely as the 1980s generation reaches marriageable age. In recent months, there have been reports of Chinese entrepreneurs searching neighboring Vietnam for women willing to go to China as wives, housekeepers or "entertainers," who often end up in prostitution. Chinese demographers, social scientists and health experts are conducting no-holds-barred studies of population imbalances and other problems, and outsiders can find a wealth of Chinese information available, some of it very critical of official programs and their unintended consequences.

With the legacy of the darkest years still in many minds, it continues to be difficult for many family planning organizations to work in China, partly because of criticism from human rights advocates and partly because experts themselves do not want to be associated in any way with programs that might be coercive. The United Nations Population Fund, which has been assisting China since 1979, recently lost its American government donation of $34 million because of accusations that Washington's money could be finding its way into areas where forced abortions still take place. Three monitoring teams--one American, one British and one international--have subsequently gone to China and reported that this accusation is not true. But that did not convince US President Bush, who is under pressure from an antiabortion lobby in Congress.

TURNING THE CORNER

In November 1999, the State Family Planning Commission of China and its major foreign partners convened a meeting in Beijing to take stock of progress since the 1994-1995 reforms. At that conference one of China's leading family planning experts, Dr. Zhao Baige, then director of pilot projects for the state commission, gave an unvarnished assessment of the challenges still facing family planning in China as it tries to move from quotas and coercive measures to client-centered "quality of care" programs.

Dr. Zhao said that the country does not have enough well qualified people or enough money to expand the voluntary, women-centered programs She also said that monitoring and evaluation were inadequate. Other experts at the meeting spoke of the need to change attitudes among family planning providers who were still often old-style administrators accustomed only to ordering people to obey laws. The need to involve men in family planning was also stressed as one of the necessary steps toward giving women more choices and more authority within relationships and families. Doctors and health aides in clinics needed to recognize the central government's policy shift and encourage it, experts said.

The burden of family planning still falls heavily on women, statistics show. Chinese women rely heavily on intrauterine devices, which account for 46 percent of contraception, according to China's State Family Planning Commission. Sterilizations account for another 46 percent (38 percent women and eight percent men). Pills, injections and other methods--including the use of condoms by men--together complete the remaining eight percent.

Reversing the pattern and giving women more choices will be a major test of officials' intentions under the new Population and Family Planning Law, which went into effect in late summer 2002. Chinese family planning leaders think it strikes a balance between old motivations and new methods.

"The law reiterated that addressing population growth is a long-term task in China but, crucially, that people's rights and interests should be safeguarded and their reproductive health ensured," said Dr. Gu Baochang, deputy executive director of the China Family Planning Association, a member organization of the London-based International Planned Parenthood Federation.

"This is the clearest indication yet that we're seeing a move away from the old demographic-led family planning policy," Dr. Gu said by email, describing his association as a national nongovernmental organization dedicated to monitoring the implementation of recent reforms and supporting people's needs. "For us at the China Family Planning Association the new indicators for success are not demographic but factors such as informed choice, privacy and client satisfaction. The pace of change is accelerating but there is still a lot to do."

BARBARA CROSSETTE was a correspondent in Asia for the New York Times and later chief of its United Nations bureau.