China - health policy reports The Effect of China's...

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n engl j med 353;11 www.nejm.org september 15, 2005 health policy reports 1171 The Effect of China’s One-Child Family Policy after 25 Years Therese Hesketh, Ph.D., Li Lu, M.D., and Zhu Wei Xing, M.P.H. China’s one-child family policy has had a great ef- fect on the lives of nearly a quarter of the world’s population for a quarter of a century. When the policy was introduced in 1979, the Chinese gov- ernment claimed that it was a short-term measure and that the goal was to move toward a voluntary small-family culture. 1 In this article, we examine to what extent this goal has been achieved and the implications for the future of the policy. First we explain why the policy was introduced and how it is now implemented. We also examine the conse- quences of the policy in regard to population growth, the ratio between men and women, and the ratio between adult children and dependent elderly par- ents. Finally, we examine the relevance of the pol- icy in contemporary China and whether the time has come for the policy to be relaxed. In 1979, the Chinese government embarked on an ambitious program of market reform following the economic stagnation of the Cultural Revolu- tion. At the time, China was home to a quarter of the world’s people, who were occupying just 7 per- cent of world’s arable land. Two thirds of the popu- lation were under the age of 30 years, and the baby boomers of the 1950s and 1960s were entering their reproductive years. The government saw strict population containment as essential to economic reform and to an improvement in living standards. 2 So the one-child family policy was introduced. The policy consists of a set of regulations gov- erning the approved size of Chinese families. These regulations include restrictions on family size, late marriage and childbearing, and the spacing of chil- dren (in cases in which second children are permit- ted). The State Family Planning Bureau sets the over- all targets and policy direction. Family-planning committees at provincial and county levels devise local strategies for implementation. Despite its name, the one-child rule applies to a minority of the population; for urban residents and govern- ment employees, the policy is strictly enforced, with few exceptions. The exceptions include families in which the first child has a disability or both par- ents work in high-risk occupations (such as min- ing) or are themselves from one-child families (in some areas). In rural areas, where approximately 70 percent of the people live, a second child is generally allowed after five years, but this provision sometimes applies only if the first child is a girl — a clear acknowl- edgment of the traditional preference for boys. 3 A third child is allowed among some ethnic minori- ties and in remote, underpopulated areas. The poli- cy is underpinned by a system of rewards and pen- alties, which are largely meted out at the discretion of local officials and hence vary widely. They include economic incentives for compliance and substan- tial fines, confiscation of belongings, and dismissal from work for noncompliance.
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China - health policy reports The Effect of China's...

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