November 1, 1998

For One-Child Policy, China Rethinks Iron Hand

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    BEIJING -- China's family planning system, notorious for the harsh rules and punishments it deploys in its quest to limit births, has quietly started urging its workers to soften their approach, hoping to improve its often tense relationship with Chinese women.

    In a small but rapidly increasing number of counties, officials say they have eliminated the onerous system of permits for pregnancy and quotas stipulating how many children can be born in a year, giving women far greater choice in deciding when to have a child and somewhat more leeway in deciding how many children to have.

    The ultimate aim is still to control this vast country's population growth, yielding families with one child in the cities and generally two in rural areas. But officials say they now hope to achieve that end not by fiat and coerced abortions, but through a broader women's-health system that discourages large families through patient education, contraceptive choice and heavy taxes for couples who choose to have an additional child.

    "We are expanding our programs and changing our attitudes," said Cong Jun, a director general at the State Family Planning Commission. "We want to change from an administrative program focusing on numbers to more of a service-oriented approach." Just last week, the commission issued regulations prohibiting grass-roots family planning workers from forcing women to undergo abortions or sterilization, although officials contend such coercion is rare.

    The new-style approach, which was officially first tried as a furtive experiment in six counties several years ago, has not affected the vast majority of Chinese women -- most do not know it exists. But dozens of similar programs have taken root across the country in the last 18 months, with at least the tacit support of the commission.

    "There has been a big change in approach and these kinds of changes have been expanding rapidly," said Tu Ping, a professor at Beijing University, who has urged change. This is the first time this system's leaders have sanctioned relaxing the core controls, although some women have long skirted regulations by having unapproved children and some local officials have tolerated it.

    But it is a relatively small experiment in a variegated country of 1.26 billion, and many obstacles remain, from dissent among high officials to the ingrained habits of local family planning officials accustomed to strong-arm techniques, to the deep suspicion of women toward a system whose methods they have long regarded as brutish and capricious -- even as they have supported population control, its ultimate aim.

    A 29-year-old Communist Party member and hospital administrator from southern China, who spoke on condition that she be identified only by her surname, Zhang, said that less than two years ago family planning officials at her work site stripped her of her job, stopped her paychecks and held her down for a pelvic exam to check her fetus' age when they asserted that she had become pregnant before obtaining her permit to have her one and only child. She said a shift in approach would be welcome.

    "I think that if these policies can be implemented it would be better for all of us," she said. "It would be a big improvement for Chinese women."

    In recent years, the Family Planning Program has increasingly seemed to be an anachronism. High-powered couples who choose jobs and buy homes and travel the world are thrown back into a Mao-era time warp when they want to have a child, which in most places still requires gaining permits from the local government and a woman's employer before pregnancy occurs.

    Women can be turned down if their company or neighborhood has exceeded its quota of births for the year. And couples who dare to have a child without permits, or -- worse -- an illegal second child, can face heavy financial penalties, job loss or, in some cases, police detention.

    In areas with the new family planning programs, there has been change. In Shanghai and the wealthy seaboard region of northern Zhejiang Province, women no longer need approval to have their first child. Some districts in Beijing are experimenting with this system and Ms. Cong said the whole city would probably adopt the change.

    At the same time, a number of family-planning clinics are undergoing makeovers so that dreary offices whose primary function used to be inserting IUD's and performing tubal ligations or abortions now are offering an expanded range of services from wide-ranging contraceptive counseling to support for breast-feeding mothers.

    Also in these zones, officials emphasize that people who are technically allowed only one child (generally city dwellers and rural residents with a son) may have a second without fear of punishment. They simply pay a "family planning fee" to cover the cost of an additional citizen.

    Officials here assert that having an extra child has never really been regarded as a crime and that the payments are not "fines," as they were commonly called in the past. That may be news to people like Qu, a farmer in rural Hebei Province who spoke on condition he be identified only by his surname. He said he was detained for a week by the public-security bureau two years ago after his son had an unapproved second child. But where the new system has taken hold, the tenor of family planning has changed.

    Chen Lingjun, a well-dressed 29-year-old who had brought her 5-month-old son into the Tianlin subdistrict family planning center in Shanghai to have a small scrape on his head checked, said: "I think I'd really like to have a second, a girl. When the time comes, if we really want another and we can afford it, we will pay."

    But Shanghai is the most cosmopolitan city in China, and its population is shrinking anyway. It is less clear how this policy will be received in more conservative cities, like Beijing, or in China's vast rural areas, where larger families are considered desirable and sons essential, where health workers are not accustomed to giving women choices and women are not accustomed to having them.

    In rural Heshan village in the midst of Zhejiang's fertile plains, Yang Lizhen, 35, sat in a whitewashed sitting room adorned with posters of Hong Kong pop stars and explained how she had an IUD put in nine years ago after the birth of her daughter. A factory worker with cropped hair and a broad smile who speaks only her provincial dialect, she looked puzzled when asked if she had considered other contraceptives.

    "I don't know about other methods," she said. "I go to the family planning center three or four times a year where she checks my IUD. I have not been informed about other choices."

    In 1997, only 39 percent of women who underwent tubal ligation had counseling before surgery, according to the Family Planning Commission. The vast majority of Chinese women still have an IUD inserted after the birth of a first child and are sterilized after the second, although in the cities that is changing.

    The modern family-planning clinic in Yuyao City in Zhejiang, where counselors provide up-to-date advice on sex and contraceptives, also dispenses a jarring reminder of the system's authoritarian policies: an advisory to newlyweds that if they have certain medical conditions -- from schizophrenia to colon polyps to congenital hearing loss -- they are forbidden to have children.

    Ms. Cong of the State Family Planning Commission said that family-planning workers would have to change their attitude and, to that end, the commission has been sending officials to courses in the United States and to Thailand's voluntary family-planning clinics to "show them that there are other options for accomplishing our goals."

    "China has made a great effort to change to a client centered program -- and that is a very welcome thing," said Dr. Ardash Misra, an official of Partners in Population and Development, an organization devoted to promoting voluntary population control in third-world nations, which accepted China as a member late last year.

    But foreign experts say that China will also have to reshape the family-planning hierarchy, in which promotion has depended on enforcing a low birth rate. "They'll really have to redefine what is a good family planning cadre," said a Western health expert based in Beijing. "Otherwise there will be no chance for change."

    The new programs have taken root in various ways. The State Family Planning Commission is financing official experiments in more than a dozen locations. Private foundations, like Ford and Rockefeller, have added money and expertise to the mix. The United Nations Population Fund has helped the commission put together similar programs in 32 counties -- an act that has prompted Congress to withhold financing for the agency, saying it did not want American money spent in a country that performs so many abortions.

    But there has been bottom-up support as well. When a private group organized a training seminar for workers from official test counties, officials from dozens of other cities turned up as well.

    "Reproductive choice" retains a carefully circumscribed meaning in China. The general policy is that only certain families may have more than one child: those who belong to ethnic minorities, rural families whose first child is a daughter, families where both parents are themselves only children, and families in which the first child is handicapped.

    Others who want an additional child pay stiff fees. In Shanghai, the fee is three times the combined annual salary of the parents. In Zhejiang, it is 20 percent of the parents' combined salaries for five years. In Qinghai Province, the government has added a carrot to the stick, offering smaller families special low-interest business loans.

    Planned Parenthood this is not, but Chinese seem alternately dubious and hopeful about the promise of change, particularly if the program better monitors its workers. Although officials insist that abuse is rare, it seems that almost everyone in China knows someone whose life has been turned into a hellish nightmare by zealous family planning officials, who sometimes mete out punishments that far exceed those stipulated in government guidelines.

    "We realize there existed problems and we have started to manage them," said Li Honggui, commission vice minister.

    A move away from a rigid family-planning system based on IUD's and sterilization was perhaps inevitable in a country where women now have many choices in their personal lives and can read about sex, condoms and birth control pills in magazines like Elle.

    There has also been a change in the government, where a new generation of officials, like Ms. Cong, has studied overseas and is attuned to issues of patient choice.

    But China can now afford to give women more freedom than when the One Child Policy was adopted in 1980, in the midst of a population explosion. After two decades of iron-fisted family planning, the average number of children has dropped, from almost six to about two per woman of child-bearing age, since 1970. And, in the new market economy -- where parents must pay rent, child care and school fees -- it is unlikely that a population explosion will resume.

    Many urban Chinese today only want one child. "I never thought for a moment about having a second," said Wu Aiqing, 40, on her lunch break from her factory job, fashionably dressed in a yellow blouse and long black skirt. "The state encourages us to have just one child. But anyway it's too expensive and I want to focus on my work."

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