Question

5. Evaluate the social challenges created by the “one-child” policy that
lead to the launch of “two-child” policy

a. About social health system in one child policy. Explain

b. Pros and cons of social health system in one child policy. Explain

(at least 800 words with clear headings)

Answer 1

The one-child policy was introduced in 1979 by the Chinese Government who considered population containment as essential to lifting China out of severe poverty caused by decades of economic mismanagement. Between 1950 and 1970, the population had increased from 540 million to more than 800 million.² In response, the government introduced the mostly voluntary later-longer-fewer policy in the 1970s, which encouraged later childbearing, the longer spacing between children, and fewer children. This policy led to a large fall in the total fertility rate from an estimated 5·9 births per woman in 1970, to 2·9 births per woman by 1979. Despite this downward trajectory of infertility, fears of overpopulation persisted, and so the one-child policy was introduced. Following the introduction of the policy, the total fertility rate continued to fall but less precipitously. Data from numerous sources showed that by the late 1990s the total fertility rate had fallen to between 1·5 and 1·7, and it has remained at this level since.

In October 2015, China announced that the iconic one-child policy had finally been replaced by a universal two-child policy. This change is highly significant because, for the first time in 36 years, no one in China is restricted to having just one child. In this Review, we examine the evidence for the potential effects of this shift in policy. The consequences are inevitably speculative, but a body of research has developed that aims to foresee the demographic, health, social, and policy effects of the universal two-child policy. Because much of this research is based on the effects of the preceding policy, we start with an analysis of the impact and controversies surrounding the one-child policy.

In October 2015, China’s one-child policy was replaced by a universal two-child policy. The effects of the new policy are inevitably speculative, but predictions can be made based on recent trends. The population increase will be relatively small, peaking at 1·45 billion in 2029 (compared with a peak of 1·4 billion in 2023 if the one-child policy continued). The new policy will allow almost all Chinese people to have their preferred number of children. The benefits of the new policy include a large reduction in abortions of unapproved pregnancies, virtual elimination of the problem of unregistered children, and a more normal sex ratio. All of these effects should improve health outcomes. The effects of the new policy on the shrinking workforce and rapid population aging will not be evident for two decades. In the meantime, more sound policy actions are needed to meet the social, health, and care needs of the elderly population.

A.China is a multicultural country composed of 56 ethnicities, with a diverse population of over 1.3 billion and an imbalanced economic development. The demographics of China are uneven, exaggerated by the imbalanced economy, by a large number of migrant populations, and by rapid aging. The average life expectancy is 73 years (Peng et al., 2006; Year Book, 2008a; Zhao, 1999). Compared with developed countries, China’s birth rate is still high; however, there was a declining trend in the past decade. In particular, after establishing a basic national policy of family planning, the birth rate dropped from 36% in 1949 to 12.10% in 2007. Meanwhile, mortality declined from 20% in 1949 (Year Book, 1991) to 6.93% in 2007 (Year Book, 2008b). As a result, China’s population has an aging trend. The United Nations predicts that more than 453 million Chinese will be older than 60 by 2050 (World, 2004).

Since 1978 the large-scale rural labor (nongmingong in Chinese) migration has become an eye-catching phenomenon in the process of China’s social and economic development, with the deepening of reforming the open-door policy and the improvement of labor markets and related policies. The rural population has provided a vast reservoir of people willing to work for low wages in factories, at construction sites, and wherever another pair of hands is needed. Thus China’s resulting exceptionally high rate of internal migration is both the consequence and the cause of economic development. Huge internal migration from rural to urban areas was estimated at 140 million in 2005—10% of the total population. Three-quarters of this migration occurred within provinces (Hu et al., 2008). Most domestic migrations are due to rural labor migrants who are almost entirely without any medical benefits in contrast to most urban residents, and they do not enjoy the state subsidies granted permanent urban residents (Wang and Zuo, 1999). They also tend to live in crowded, low-quality housing, often at the worksite (Feng et al., 2002; Roberts, 1997; Shen and Huang, 2003). All these factors aggravate the dangers of disease, such as maternal and infant diseases (Asweto et al., 2016; Hu et al., 2008; Shaokang et al., 2002; Yang et al., 2005).

China established a “one family, one child” policy in 1979 and a family planning law in 2002. Under the one-child policy, couples were encouraged to marry late, usually in their mid-20s, and allowed to have only one child. This policy brought a conspicuous birth rate decline from 37.88% in 1965 to 18.21% in 1980 (Flaherty et al., 2007). In 1985 the birth rate had rebounded to 21.04% because of the “1.5 policy” of 1984, which permitted peasants whose first child was a girl to have a second child after a suitable period. Since then, the birth rate has been declining gradually. Now, it is under 15%. To date, China’s one-child policy has contributed 200–400 million fewer people to the total growth of the world population (King, 2005). The one-child policy, insofar as it limits couples to have one or two children, leads to more attention to the diagnosis of birth defects and greater involvement of parents in child care, which is named “healthy birth and child care” (Short et al., 2001). The law on maternal and infant health (launched in 1994) requires physicians to recommend a postponement of marriage if either member of a couple has a genetic disease. If one spouse has a serious hereditary disease, the couple may only marry if they agree to use long-term contraception or to undergo sterilization. If prenatal tests reveal that a fetus has a serious hereditary disease or serious deformity, the physician must advise the pregnant woman to have an abortion, and the law states that the pregnant woman is supposed to follow this recommendation. A survey on genetic research and practice was done on 402 genetic service providers in China, using a Chinese version of an internationally circulated survey questionnaire on ethics and genetics. In all, 255 participants completed the questionnaires (63%). The majority of respondents (89%) reported that they agreed with current Chinese laws and regulations on termination of pregnancy for genetic abnormalities on the basis of considerations of population control and family planning (Mao and Wertz, 1997).

Public Health Care Structure in China

In 2005 the fund allocated to the health sector was 60,150 million renminbi, about 1.77% of the total government budgetary expenditure in China. In 2006 there were 308,969 health institutions in urban China and 609,128 village clinics in rural China (Health, 2007). There are wide differences in the health care systems between urban and rural areas, that is, Urban Health Care System versus Rural Health Care System, but both urban and rural health services delivered through three levels: primary, secondary, and tertiary (Shao et al., 2013).

Urban Health Care System

In the urban system, the Center for Disease Control and Prevention (CDC) operates at provincial, city or district, and community levels (Zhao et al., 2011). Meanwhile, there are three types of hospitals in the urban medical care system, which are tertiary, secondary, and primary hospitals. A primary hospital has basic facilities and fewer than 100 beds, offering prevention, sanitation, health education, and treatment services for a specific community. The urban payment system has two stages. Before 1994 the Government Insurance Scheme and Labor Insurance Scheme were the mainstream insurances, and only the employees of government agencies, public institutions, and state-owned enterprises were covered by these two insurance schemes, which also partly covered the cost of health care for the dependents of employees. According to a national survey in nine provinces in 1986, less than 14% of the urban population was not covered by any health insurance or plan (Ministry Health, 1989). After 1994 a new urban employee basic health insurance scheme—which covered more of the urban population, including the employees of the institutions as mentioned above, foreign-invested enterprises, individual enterprises, and those who were urban inhabitants but had no stable jobs—was developed to replace the two schemes. In this scheme, government-run schemes have decreased while nonmainstream insurances (e.g., commercial schemes) have increased.

b.The pros and cons are:

Pros

1.Due to large variation in how the one-child policy was implemented across regions and ethnicities, researchers are able to exploit natural variation in their analyses, which makes empirical results reliable.

2.The strictness of policy implementation is associated with promotion incentives for local leaders.

3.The one-child policy significantly curbed population growth, though there is no consensus on the magnitude.

4.Under the policy, households tried to have additional children without breaking the law; some unintended consequences include higher reported rates of twin births and more Han-minority marriages.

Cons

1.There is no solid evidence that the one-child policy contributed to human capital accumulation through the traditional “quantity–quality” trade-off channel.

2.Current economic studies mainly focus on short-term effects, while the long-term or lagged effects are substantially understudied; thus, statements about consequences and suggestions for policy designs are still missing.

3.The one-child policy is associated with significant problems, such as an unbalanced sex ratio, increased crime, and individual dissatisfaction toward the government.