FHI - July 1998

Family Planning and Its Effects on the Lives of Women in China -- July 1998

Research Triangle Park, NC, USA -- China's birth rate has declined dramatically since the government instituted its one-child per couple policy in 1979. While population growth has slowed and the economy has prospered, little is know about how the widespread availability of family planning has affected individual women and men in China.

To learn more, the China Population Information and Research Center (CPIRC) conducted a study in two counties in the northern part of Anhui province and two counties in the southern part of Jiangsu province. South Jiangsu is on China's east coast and has experienced a booming economy and a rapid decline in fertility. North Anhui, an inland province, is primarily rural with a slower decline in fertility.

In presenting findings, investigators acknowledged difficulties in conducting research in China. Study participants may have been reluctant to express their own ideas and opinions. Also, because contraceptive use is so widespread, and because the government closely monitors contraceptive use, study participants' responses reflect limited choices in controlling their own fertility.

Among the findings:

Generational differences: Older and younger couples had different experiences with family planning. While contraceptive were widely available to younger couples, they were not available to older couples.

Some older women expressed regret that they had not had access to family planning when they were young. "My parents had eight children," said one 56-year-old woman in South Jiangsu. "I'm the second. My father died when I was 20 -- there was no money for the doctor. Some siblings were given to other families. Having too many children -- not only do the parents suffer but also the children, with bad nutrition and bad housing."

At least two-thirds of the respondents in both provinces said family planning had improved many aspects of women's lives, including their health, household work, education, opportunities for economic activity, and leisure. "Family planning is good for health," said one 28-year-old woman from South Jiangsu. "We are relaxed in comparison to our parents, who were tired."

Family planning and women's work: As more women accepted family planning, the time spent in childbearing decreased, allowing women to pursue work opportunities outside the home. This has led to increased decision-making authority for women within the household. One 44-year-old woman from South Jiangsu said, "Women's status is higher now, of course. In the past, women couldn't work outside the home. Women my age all have jobs." Although the boundaries between traditional gender roles are slowly changing, women still bear most of the responsibility for housework, such as cooking and cleaning. When young women and men were interviewed about their ideal spouse, they stated that husbands should be the chief financial provider for the family and the wife should be responsible for the housework and child care.

Son preference: China's one-child policy conflicts with the long-held cultural ideal that males are more important than females. Even as the small family norm has come to be accepted, couples' preference for sons, particularly in North Anhui, continues. When asked which sex child they preferred before their first child's birth, fewer than 13 percent of men and women in South Jiangsu said they would prefer a son, while in North Anhui 25 to 30 percent of women and men preferred sons. Residents of North Anhui said their primary reasons for wanting sons were to carry on the family name and to support parents in their old age. Using ultrasound machines to determine the sex of a fetus is illegal but does occur, and if the fetus is a female, it may be aborted. Some women, particularly from North Anhui, said they feel pressure from family members, especially mothers-in-law, to have at least one son. According to one woman from North Anhui, "If you have a son, even your house will look higher." Another young woman said, "If you have no son, you have missed something in life. You didn't accomplish something."

Acceptance of one-child policy: After nearly 20 years of the one-child population policy, most people, particularly in South Jiangsu, are reconciled to the reality of small family size and acknowledge the positive aspects of having fewer children. In the early days of the program, however, it was difficult for family planning workers to persuade people to adopt contraception. As one man from North Anhui said, "At the beginning of the family planning program, people were not afraid of the sky or the earth. They were most afraid of the family planning propaganda truck with the loudspeaker."

Men's use of family planning: While study participants said family planning services are available for men, contraceptive use is primarily women's responsibility. However, many male and female study participants said men should play a greater role in family planning. More than one-third of study participants in South Jiangsu said men should accept vasectomies, while more than half said men should use condoms. In North Anhui, the figures were 60 percent and 52 percent, respectively. More than 90 percent of women and men in both provinces said husbands should care for their wives after female sterilization. Only 8 percent of women and men in South Jiangsu said men should have nothing to do with family planning, while approximately 19 percent said this in North Anhui. One young man said, "I wish we had better methods for males."

Family planning use: Not surprisingly, contraceptive use in China is almost universal. Ninety-two to 99 percent of study participants said they had used contraception at some point in the lives. More than 97 percent of women in South Jiangsu and 91 percent of women in North Anhui said they currently use contraception. Nearly 82 percent of contraceptive users in South Jiangsu said they used an intrauterine device (IUD), while 31 percent of users in North Anhui used this method. Nine percent of women in South Jiangsu used female sterilization, while almost one-third of women in North Anhui had undergone sterilization. Male sterilization was much more common in North Anhui, where 29 percent of women reported that their husbands had undergone the procedure; the figure in South Jiangsu was less than 1 percent.

Contraceptive failure. Nearly 20 percent of women in South Jiangsu and 9 percent in North Anhui said they had become pregnant due to a contraceptive failure. Researchers said this percentage may decrease as newer, more effective contraceptive methods become available in China.

Differences in family size: Women in South Jiangsu, where the government has enforced China's one-child policy since its inception, had an average of 1.3 live births, compared to 1.8 children in North Anhui, which more readily allows couples with a daughter to have a second child.

The study surveyed some 2,000 women and men in each province. Researchers also held discussions with 375 women and men -- including married women of childbearing age, unmarried women and men, older couples and female entrepreneurs -- through focus groups.

The research was part of the Women's Studies Project at Family Health International, a five-year research project designed to explore the impact of family planning on women's lives. China was one of 10 countries that participated in the project. Research in China was funded by the Rockefeller Foundation.

In analyzing study results, researchers made several recommendations for ways to improve reproductive health services.

First, family planning programs should improve quality of care and extend services to young adults and to older women, rather than focusing exclusively on women of reproductive age. In addition, women and men should have access to and the choice to use a wider array of contraceptive methods -- not only the IUD and female sterilization. Also, men should become more involved in using contraceptives, and vasectomies should be available for those who want them.

The government, policy-makers and health providers should work collaboratively to promote the value of daughters. They should educate couples about economic value of daughter's work; about the contributions women make to the home, in terms of domestic chores, care for parents and children, and income generation; and about the value of women as individuals in their own right.

FHI is a US-based, not-for-profit organization that provides the highest quality research, education and services in family planning, STDs/HIV and family health to improve the health and well-being of populations worldwide.

For more information about these studies, contact Barbara Barnett, Senior Science Writer/Editor, Family Health International, at 1-919-544-7040, Ext. 482. Or fax 1-919-544-7261 or e-mail: bbarnett@fhi.org.

See Also:

Family Planning and Its Effects on the Lives of Women in China -- July 1998