For most children in China, it is illegal to have a brother or sister. The One-Child Policy, alternatively named the ‘Every Other Child Must Die Policy’ by activist organization All Girls Allowed, was enforced in 1979 as a means to mitigate the social and economic burden of an overpopulated country.
This policy highlights the biggest underlying debate in health care: compromising individual autonomy for the sake of the greater good. The implications of the One-Child Policy are rife with controversy, and include the sterilization of women, forcible abortion, and infanticide. Most families that are expecting a second child in China are initially fined. Considering that these fines are several times higher than the average annual household income, the majority of Chinese women are ultimately coerced or physically forced into having an abortion.
To date, 336 million children have been aborted in China. Forced abortions continue to occur despite an official ban that was instated after a picture of a mother and her forcibly aborted 7-month-old was widely shared on the internet and caused local and global frenzy.
Feng Jianme after the forced abortion of her 7-month-old.
This woman, like many others, was unable to pay a fine of over $6000 after becoming pregnant with her second child. She was subsequently kidnapped, restrained, and forced to abort her baby. According to her husband, she attempted suicide after the traumatic incident. The Chinese government, after being notified about her story, offered the family money as compensation. To no surprise, members of that family did not believe that money could compensate for their loss.
Forcing women to have abortions against their own will, particularly late in their terms, is an issue that extends far beyond pro-life or pro-choice debates. Besides being a human rights violation, this policy puts women’s lives at risk. It also has broader health implications. For instance, because forced abortions and sterilizations are usually done under unsterile conditions by untrained personnel, women may develop critical health problems that last a lifetime. In addition, since this policy was initiated, suicide has become the number one cause of death for young women in the country.
An article written by Max Fisher for the Washington Post highlights the paradoxical nature of the One-Child policy. While local officials are expected to keep the birth rate below a certain target at the provincial level, they are not allowed to resort to forced abortions and sterilizations. Hence, lower-level officials often resort to their own means of controlling population size.
An alternative to implementing this policy without resorting to brute force would be to provide women with family planning services. However, only about half of women who live in urban areas, and 9.6% of rural women, have received contraceptive services post-abortion, which has led to unavoidable repeat pregnancies.
Despite the negative health implications of this policy, it has brought some benefits. The decreased total fertility rate in China has aided economic growth, provided opportunities for women, and improved healthcare for women and children. However, there has been controversy surrounding the policy’s effectiveness in controlling population size. According to a study that examined the long-term effects of the One-Child Policy on population growth, fertility rates had decreased most dramatically before this policy was instated. This decrease was a result of a voluntary policy that encouraged child spacing, later childbearing, and having fewer children, a policy that was not wrought with human rights violations.
The One-Child Policy ultimately highlights how governmental control of individual autonomy is justified for the sake of the greater good – essentially the biggest debate in public health. The controversy this policy has created sheds light on the challenges of alleviating a social problem, particularly when it propagates the politicization of reproductive health and leaves a human rights issue in its wake.