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Frank Dik[ddot{o}]tter: Imperfect Conceptions: Medical Knowledge, Birth Defects and Eugenics in China. (New York: Columbia University Press, 1998. Pp. ix, 226. $54.95.)

Since the 1970s, the Chinese government has engaged in a widely publicized effort to limit the size of the Chinese population. Many reports have emphasized the dangers of such policies and there have been numerous accounts of forced abortion and sterilization taking place within a system of birth quotas, as well as a growing disparity in the numbers of boys and girls brought about partly as a result of sex-selective abortion. At the same time, new-found prosperity has meant that the image of China as the "sick man of Asia" is now outmoded. The overweight urban teenager, doted on by grandparents and indulged by upwardly mobile parents, is a more commonly utilized symbol of the results of Chinese economic reform.

With urban couples limited to one child, a plethora of methods for ensuring the intelligence and health, or "quality," of offspring is eagerly utilized by the population. These vary from "commonsense" advice, such as avoiding x-rays and smoking while pregnant to extensive "foetal education" programs, which are based on the idea that the foetus can hear and be educated in the womb. According to Frank Dik[ddot{o}]tter's Imperfect Conceptions, while these ideas may seem no different from those in the West regarding the production of healthy offspring, they in fact occupy a particular place within Chinese medical discourse. Population policies and health programmes in China, Dik[ddot{o}]tter claims, are uniquely eugenicist (p. 152).

Dik[ddot{o}]tter aims to show how traditional Confucian notions of the body and reproduction were fused with concepts such as "race" and "nation" during the push for modernization in the first few decades of this century. Summarizing about one hundred Confucian medical texts, Dik[ddot{o}]tter claims that in the late imperial period there was a core belief in the importance of pregnant women living a regulated and well-balanced life in harmony with the cosmological and environmental forces in order to avoid birth defects. Men's contribution lay primarily through the quality of sperm, which could be affected by drinking, gambling, and living a life of excess. Individuals owed their primary loyalty not to the state but to the lineage. Bearing a deformed baby was often read as evidence of improper behaviour and seen as the ultimate sign of disrespect to one's ancestors.

By the republican era (1911-1949), this primary loyalty to the lineage had shifted. Notions of "race" and "population as resource" became important, especially for those Chinese reformers wanting to resist foreign powers (p. 61). In an echo of Confucian notions of self-cultivation, the nation was exhorted to strictly observe the rules of sexual hygiene, as individual self-discipline was necessary for the health of the nation. As in modernizing movements all over the world, the "uterine space" became a domain of public interest-- the state now had a right to interfere. Malformed infants came to be the symbolic representations of racial degeneration as well as proof of the existence of natural laws of hereditary (p. 69).

This potent eugenicist mix persists in the People's Republic of China (PRC), says Dik[ddot{o}]tter. After 1978, economic reform and population control policies created the conditions for a greater acceptance of eugenics discourse (p. 124). Recent population policies have focused not only on limiting the quantity of births but also on improving the "quality" of the population. This has led to the market being flooded by health manuals aimed at educating parents on how to achieve a "superior" baby Here traditional Confucian notions regarding the dangers of excess and the importance of balance have been rearticulated in a more modem language. Dik[ddot{o}]tter states that the acceptance of eugenics is so pervasive that the many voices which discuss reproduction can only do so within a eugenicist framework determined by the state.

To demonstrate this point, Dik[ddot{o}]tter refers to the recent legislation (the Maternal and Infant Health Law, 1995) which, he says, ensures that a eugenicist framework is extended nationally. Dik[ddot{o}]tter provides only a basic outline of the law, referring readers to a number of secondary sources. (That Dik[ddot{o}]tter does not discuss the law in depth is a definite shortcoming, as Imperfect Conceptions is framed around explaining this very piece of legislation.) The law calls for systematic premarital health checks in order to ensure that those deemed "unfit" for reproduction undergo sterilization before being granted a marriage permit. The aim is to prevent "inferior births" (birth defects) which could create a burden on the state (p.174). As Dik[ddot{o}]tter shows, the definitions of genetic defect, mental retardation, and hereditary disease are vague and flexible. Thus, he concludes, "the right to reproduce and even the right to exist are determined by ill-defined and partial ideas about 'geneti c fitness"' (p. 175). The laws secure the power of cadres of doctors over the reproductive decisions of the people as well as reinforcing the idea that self-discipline and sacrifice are important not only for the wellbeing of the state but also for the health of future generations (p.l76).

Eugenics laws, however, are not unique to China. Throughout Imperfect Conceptions Dik[ddot{o}]tter attempts to maintain a comparative focus. To his credit, Dik[ddot{o}]tter prefers the example of Scandinavia rather than the more hackneyed comparisons with Nazi Germany. Dik[ddot{o}]tter maintains that Chinese contemporary eugenic thought shares "a politically conservative vision of the relationship of the state and the individual in the radically fashionable language of science" with European movements for racial hygiene (p.12). An overreliance on science to solve social problems, he concludes, is particularly dangerous outside a "politically democratic system" and without a notion of "reproductive rights" (p. 185).

Unfortunately, however, these conclusions have not been adequately argued in the text. Imperfect Conceptions lacks a detailed discussion of the relationship between the individual citizen and the state during the PRC era. There are a number of flippant references to the "one-party state" but little detailed analysis. For example, the voluntary component of the 1995 Maternal and Infant Health Law is dismissed with a reference to the Tian' anmen massacre of 1989. Here, Dik[ddot{o}]tter is guilty of passing off anticommunist rhetoric in the place of detailed analysis. Claims about eugenic legislation undermining the rights of the person vis-[grave{a}]-vis the state require a substantial discussion of the notion of the person in China, as well as the notion of fights. This discussion does not take place in Imperfect Conceptions.

There are also some serious omissions. Dik[ddot{o}]tter claims that it was only with the establishment of the PRC that science and medicine became intertwined with the interests of the state (p.120). If this is so, how do we explain early marriage regulations dating back to before even 1911 which limit marriage for those deemed medically unfit?

More serious is Dik[ddot{o}]tter's omission of the Maoist period (1949-1976) from any detailed discussion (three pages). During this period the current state structure was established, as were the organizational structures relating to family planning and health generally. Concepts of state-planned reproduction and definitions of family planning were widely debated. As Dik[ddot{o}]tter briefly notes, Marxist criticism of the class-based nature of eugenics discourse meant that discussions of genetic inheritance and birth defects were more likely to be framed by Lysenkoism in the 1950s and 1960s. However, any history of eugenic thought in contemporary China needs to include an analysis of this period. It is true, as Dik[ddot{o}]tter claims, that youshengxue (the "study of excellent births," or eugenics) was politically rehabilitated as a discipline only in the late 1970s, along with demography and sociology. It is false to assume that no activity or debate occurred during this period worth mentioning. Moreover, by excluding the Maoist period, Dik[ddot{o}]tter reinforces the widespread misunderstanding that efforts to control population quantity and quality began only after Mao's death. This is not true, as population campaigns had occurred sporadically since the mid-1950s, and were widespread by the beginning of the 1970s. In fact, the introduction of the one-child policy in the late 1970s was legitimated with reference to 1950s debates and campaigns. This is important to recognise, as the issue of "quality" of population is inexorably linked to that of control of quantity.

How could a Sinologist of Dik[ddot{o}]tter's standing fail to engage with Chinese definitions of population quality? By reading quality as referring only to the realm of birth defects, Dik[ddot{o}]tter misses the fact that this term operates with a much broader meaning in China. In China, population "quality" includes cultural and educational indices, as well as the more obvious health elements. How can the current legislative and policy initiatives in China be fully understood if we do not understand the terms being used? Without a detailed analysis of the notion of population quality, an assumed similarity between terms reigns unchallenged. Does the Chinese youshengxue map directly onto what we mean by "eugenics"? In fact, is the term eugenics itself as self-evident as Dik[ddot{o}]tter suggests? Imperfect Conceptions provides no answers and fails even to recognize that these are essential problems requiring attention.

Imperfect Conceptions is still the only book-length work in English on medical knowledge and birth defects in China, and in this respect, it is useful for it makes available to a wide non-Chinese-speaking audience a number of interesting texts. Unfortunately, however, it also reinforces some pernicious misunderstandings regarding population policies in China

KAZ ROSS teaches political science in the University of Melbourne; her research is on planned reproduction in China.
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Title Annotation:Review
Author:Ross, Kaz
Publication:The Review of Politics
Article Type:Book Review
Date:Mar 22, 2000

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