Correspondence

China's One-Child Family Policy

N Engl J Med 2006; 354:877February 23, 2006

Article

To the Editor:

Hesketh and colleagues (Sept. 15 issue)1 provide an interesting survey of the effects of the infamous Chinese one-child policy after 25 years. However, I was somewhat taken aback by the authors' editorial statement that “relaxation of the policy can be considered only if fertility aspirations are such that a baby boom will not result.” Certainly, this is the same sort of argument that tyrannical regimes have given for continuing their oppressive policies, from apartheid and dictatorships to the oppression of women and just about any other human-rights violation through history. The policy of one child per family has been a terrible violation of the personal rights of millions of Chinese women. All that is necessary for the draconian policy to be removed, not just “relaxed,” is for the Chinese government to make the decision to stop such repressive measures and start dealing with the problems posed by an expanding population through moral means. I am disappointed to see the “ends justify the means” logic endorsed and unchallenged on the pages of a respectable medical journal.

Thomas R. Jackson, M.D.
Ireland Army Community Hospital, Fort Knox, KY 40121

1 References

1
Hesketh T, Lu L, Xing ZW. The effect of China's one-child family policy after 25 years. N Engl J Med 2005;353:1171-1176
Full Text | Web of Science | Medline

Author/Editor Response

We agree that the one-child policy is a violation of the human right to reproductive choice, as we acknowledge in our article. It is precisely for this reason that it is so controversial. But we should not judge the Chinese by Western standards. Few Chinese see the policy as a human-rights violation. Most (though not all) accept it with equanimity, even in the cities where the one-child rule is enforced. This is perhaps less surprising when one considers the overcrowding in Chinese cities, the pressures of child care with two working parents (as is usually the case), and the high cost of raising children.

The Chinese authorities would argue that the policy has contributed to improvements in human rights by lifting more than 200 million people out of poverty and by raising living standards for the majority of the population. In an increasingly interdependent world, where available natural resources per capita are decreasing, the Chinese government should perhaps be applauded for having the courage to take unpopular measures to control population growth.

Therese Hesketh, Ph.D.
Institute of Child Health, London WC1N1EH, United Kingdom
t.hesketh@ich.ucl.ac.uk

Zhu Wei Xing, M.P.H.
Zhejiang University, Hangzhou 310006, China

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