Easing Family Planning Rules Leads to Fewer Abortions and More Baby Girls, Chinese Province Finds

CHANGJIANG, Hainan Province, China — Sixteen months after lifting birth-spacing rules for rural families, officials here say there are fewer abortions. They expect the new policy, coupled with advocacy and incentives to counter son preference, to result in a more balanced sex ratio among newborns.

County residents report that family planning workers are listening to their concerns, providing more information and offering a choice of contraceptive methods to suit different circumstances. Hospital deliveries, now subsidized and actively encouraged to reduce maternal deaths, have increased markedly.

Changjiang County has experimented with family planning policy and worked to improve reproductive health services as conditions of support from UNFPA, the United Nations Population Fund. Its success led Hainan authorities in late 2004 to abolish birth-spacing restrictions throughout the province. Three other provinces - Gansu, Jilin and Shanghai - have also done so, and others are considering similar reforms.

Changjiang is home to 245,000 people, including 100,000 from the Li ethnic minority group. It is one of 30 rural counties throughout China where UNFPA is supporting comprehensive and voluntary reproductive health care and training providers in quality client-oriented services and information.

More than 800 other counties have followed its lead in introducing a service-oriented approach to reproductive health that stresses informed choice, confidentiality, privacy and follow-up. Nationwide quality standards developed by the National Population and Family Planning Commission in 2003 have removed birth targets and quotas (limits on the number of births allowed in a given administrative area), in line with the practice in UNFPA-supported counties.

Among contraceptive users nationwide, fewer women are undergoing sterilization and more are opting for reversible methods, especially intrauterine devices. Condom use has also increased.

Hu Daji, Deputy Director of the Hainan Population and Family Planning Bureau, says his organization’s focus “is not just providing family planning, but improving the reproductive health status of our clients.” In July 2004, Hainan authorities agreed to let Changjiang County lift the birth spacing requirement. Four months later, they lifted the requirement throughout the province.

Changjiang County residents report that family planning workers are listening to their concerns, providing more information and offering a choice of contraceptive methods to suit different circumstances.

Previously, rural couples in Hainan were permitted to have a second child, but before the recent policy change they had to wait four years after the first birth or pay a penalty. A substantial 'social compensation fee' - more than twice the average annual income - is still imposed for having more children than regulations allow: one for urban couples, two for rural ones and three for minority families with two daughters

In 2003, when birth spacing rules were still in place, the social compensation fee was applied in 299 cases in Changjiang County; last year in 54 cases and this year 37 so far, according to Li Zhiyong, Director of the county family planning bureau.

“Lifting birth-spacing rules is an important step towards a fully voluntary approach to pregnancy decisions,” says UNFPA Representative Siri Tellier. “Around 40 per cent of penalties involve cases of birth spacing, so eliminating that requirement is significant. However, it goes only part way to meeting international human rights standards. We would like China to eliminate any economic penalties for out-of-plan births.”

(Chinese law prohibits the use of force to impose birth limits. In an abuse case reported earlier this year in Shandong Province, the National Population and Family Planning Commission investigated and announced that administrative action had been taken against local officials responsible.)

Wang Yingjie, a nurse at the Changjiang County maternal and child health clinic, says, “In cases of pregnancy outside the regulations, we may communicate with the client. But if she and the family insist on having the baby, she will have it.”

“There are strict procedures for collecting the social compensation fee,” Hu Daji states. “Families with more babies tend to have a lower economic status. Collection of the fee from poor families can be postponed.”

“To be part of the UNFPA project, our pilot county was required to reduce the number of social compensation fee cases,” Hu says. “We had to think about how to do that. To lift birth-spacing rules, we needed to give up our old way of thinking.” He acknowledges that the policy change is likely to lead to more births in the short term, but he doesn’t believe births will increase in the long run.

UNFPA has officially recommended that the fees be phased out.

“As a result of the UNFPA project, we get lots of information and have been introduced to new concepts for providing human-centred services,” says Wang Ying, director of the family planning service station in Yuetian Township. Staff from the station routinely visit the township’s 28 villages to provide family planning services and prenatal exams, and to promote safe motherhood.

Although there is a midwife in each village, providers say nearly all of the pregnant women plan to deliver their babies at the hospital, a big change compared with just three years ago before subsidies were introduced. The county now pays about three fourths of the costs of a standard delivery.

“Birth quotas are no longer sent down to the townships and birth-spacing requirements have been lifted,” Wang notes. “Clients can choose when to have a baby.” The township has experienced a slight increase in births since the policy was changed, and by her estimate, a two thirds reduction in abortions.

Family planning officials believe that lifting birth-spacing rules and reducing abortions have had an impact on the hidden problem of sex-selective abortion. Son preference remains deeply rooted in rural China, and Hainan is no exception. The practice of aborting female foetuses after using ultrasound to determine their sex, although outlawed in 1994, is believed to have continued. In 2000, Hainan had the highest sex ratio at birth of any province, 135 males for 100 females.

Chinese authorities say that, in recent years, they have become more active in responding to this problem, as a part of overall efforts to improve women’s status and living standards. UNFPA has supported the drive to address the issue, particularly by organizing an exchange of experiences with other Asian countries that also have a sex ratio imbalance due to son preference.

In Hainan, married women cannot get an abortion after 14 weeks of pregnancy - when ultrasound can determine the sex of the foetus - unless there is a medical justification. While definitive data are not yet available, provincial officials say there are clear indications that the sex ratio imbalance has declined significantly since this policy went into effect.

In addition to mounting advocacy campaigns promoting gender equality and the rights of girls and women, Hainan has experimented with economic incentives. Couples that only have daughters get a larger housing subsidy than those with sons. Those with only one child receive a special pension when they turn 60. To encourage higher enrolment of girls, school fees were eliminated for all children in 2003.

As a result, “there is now less pressure on families to have sons,” asserts Zhou Jin, who heads the provincial family planning bureau’s education department.

But changing underlying attitudes will take time, Hu Daji admits. “One thousand years of traditional concepts will not be changed in a couple of years. Son preference is closely related to the level of production. Men are most of the rural labour force. Most members of the older generation live with their sons.”

“With development and increased living standards in China, I am sure the concepts of birth will change,” Hu says. “Our challenge is to not have more births and to protect clients’ rights. These are tough issues we need to work on. If we do things right, it will show the capability of our family planning workers. I am sure that if our programme is human-centred, there will be a big change within 10 or 20 years.”

— William A. Ryan