Initially analyzing the characteristics and evaluated indexes in rural areas and making relative policies]

20% of rural family planning (FP) programs in China have an unsatisfactory performance. A study was conducted in four townships with poor FP program performance in Pengxi County, Sichuan Province. Some common characteristics of these townships are as follows. Lack of concern about the FP program on the part of the local leadership. 2) Resistance of local people to FP communication and education; 96% of 426 families interviewed wanted to have 2 children, and only 3.7% wanted 1 child. 3) Lack of enforcement of the incentives and disincentives stipulated in the FP policy. 4) Lack of service delivery back-up in FP programs with a shortage of trained professional staff to provide clinical services and a shortage of the necessary medical facilities or equipment to meet the needs of FP service delivery. 5) The large number of early marriages, early child-births, extra-marital child-births without quota. At the present time, there is not specific quantitative standard to evaluate the FP program performance in a particular district. 3 indicators are appropriate for comparison of program performance. 1) Has the annual birth control target for the district been met? 2) The percentage of births with in the FP quota. Under 60% of births within the quota should be considered poor performance. 3) Over 20% of unplanned pregnancies reflect poor performance in the areas of birth control education, and contraceptive service delivery. The following are suggestions for solving the problems of poor program performance. 1) Community leaders should be evaluated on a per capita production output value rather than on total value. Their achievements should also be linked with their salary increases, promotions and bonuses. 2) One-child families should have a priority in receiving financial aids for development. 3) Governmental and non-government organizations should work together to promote the implementation of FP policies. 4) Service delivery systems should be strengthened by promoting population and FP education to families and in schools. Funding should be made available to increase the capability of birth control service delivery in terms of staff training, provision of equipment and housing and improvement in the quality of services. 5. Full use should be made of the potential of village leaders to take personal responsibility for every aspect of the FP.     

The family planning law should be issued as soon as possible]

China is facing a baby boom in the next ten years. Now is a perfect time to formulate legislature on family planning (FP) to strengthen the current policy and regulations in order to slow the momentum of excessive population growth. As a result of current economic reform and implementation of the rural household responsibility system, the migrant population has increased tremendously. The fact that millions of rural farmers are shifting to non-agricultural areas created new challenges to the effectiveness of traditional measures of the FP program. Promulgating laws and legislature will facilitate the job of FP. The law should stress the restriction of population growth and encouraging one child per couple. In the rural area it is not feasible to implement the one child policy indiscriminately. Under the policy of one child for a majority of the couples, no third birth is permitted. Local governments should be given the authorization to grant permission for second births for special cases within the birth planning quota. Allowing people living in poor and less developed areas to have more children and granting mothers of handicapped children permission to have an additional child were in fact facilitating the deterioration of the quality of the population. Some current policy in rural income distribution and social welfare was beneficial to large-sized family. Such policies should be changed to give incentives to small-sized families.     

We must pay attention to the difference between the original intention and the current status of family planning]

Due to imperfections in the current family planning (FP) policy, and the differences un program implementation in urban and rural areas, the fertility of the urban population with higher IQ scores is under control but this is not the case for the rural population. Among rural couples, one child is rare and two or three are commonplace, while in cities over 70% of couples are having one child. In the metropolitan cities, this figure is about 90%. In the rural areas, provision of education is a serious problem because of insufficient resources, a lack of qualified teachers and inadequate facilities. At the present, at least 3 million school age children in rural areas can not go to primary school. Besides there is a big contrast in FP practice between Han nationality and minorities. Population growth is basically under control among the more advanced Han nationally but not among the less advances minority nationalities. This growth rate among the minority population was about 50.27/1000 in the past five years, which is alarming. Furthermore, the couples given opportunity to have a second child are often those whose first child had birth defects or is mentally retarded, whereas couples with a normal child can have only one child. This has become a vicious circle, since subsequent children are more likely to have the same birth defects. It was discovered from a 1983-85 survey that the prevalence of birth defects was 12.8/1000. The current situation is that the fertility of urban, educated, and healthy people is restricted while the less educated, those living in less developed areas, and those with health defects are having more children. The outcome of this situation is the decline of national population quality, which greatly deviates from the original intention of the FP.     

We must complete the population control system to control the population peak and achieve our population goal]

Since 1986, China has experienced another baby boom which is expected to last till 1997. If no effective measure is implemented to check population growth, the population target of around 1.2 billion will not be achieved. The author proposed four population regulation mechanisms that need to be strengthened. First, ideological education needs to be used to change people's perceptions about family size, so that couples would willingly accept small families. Second, financial incentives and penalties need to be used to direct people to regulate their fertility. The incentive and penalty technique directly affect the interests of the family and is likely to produce rapid results. Third, legislation can be used to regulate reproductive behavior, the laws and legislation which restrict social behavior should be utilized for population control purposes. Once legislation on fertility regulation is passed, those who violate the law can be penalized. Furthermore, legislation gives family planning (FP) workers legitimacy in implementing the program and can help avoid disputes in the process of FP program implementation. Fourth, provision of contraception and abortion services is an important mechanism to ensure the realization of the objectives of population growth control. Meanwhile, the effectiveness of contraceptive methods and the acceptance of abortion depends on the research and development of contraceptive technology and on abortion techniques. These fertility regulatory mechanisms have not be adequately established, and their functions have not been fully utilized. The current FP program is hampered by simplistic ideological education, abusive use of incentives and penalties, lack of legislation, and unmet needs in contraceptive development. To achieve the population targets, these mechanisms need to be strengthened.     

Comparison and fairness in family planning]

There are two kinds of comparison in family planning (FP) practice. First, people compare the number of children they have with their desired family size. Second, people compare their number of children with other's. The extent of their satisfaction from the comparison often depends on their expectation. And people's expectation about their family size may have an impact on the level of fertility. One task in a FP program is to regulate people's objects for comparison and to reduce the number of children they expect to have. But, changes in people's desired number of children are largely dependent upon the socio economic charges which can not be achieved in short time. Therefore, it would be more advisable to direct people to compare their fertility behavior with those of couples who have only one child, rather than those who have 3 or 4. Satisfaction with family size also comes from a feeling of fairness. People not only look at what they get, but also at what others get. Fairness and justice in FP program implementation is important. If those who violate local birth control policies and regulations are not properly punished, other people would feel that the situation is unfair and they would regret that they did not do the same. The pressure brought by over-population to socio-economic development has been gradually felt by most people. But, it is still difficult to have them strictly observe the present fertility regulation policy. If restrictions of various kinds are enforced and education and publicity are used, people will feel that they are being treated fairly. This will facilitate the promotion of the FP program.     

基层民主自治进程中乡村计划生育政策落实的困境及出路——基于基层治理中“不出事逻辑”的分析视角

本文对基层民主自治进程中乡村计划生育政策落实的困境及出路进行了探讨。基层民主自治是我国的一项基本政治制度,实行基层民主自治是发展中国特色社会主义民主政治的重要内容。但是在乡村推行基层民主自治的过程中,乡村计划生育政策的落实陷入一些困境,这些困境集中表现为计生政策与村民生育愿望、与村委会选举、与社会保障体系、与利益导向机制及与其它相关部门和政策的冲突与矛盾。鉴于此,本文相对应地提出了加强宣传教育、完善村民自治、健全社会保障体系、健全舆论导向机制以及加强政策的同向性与协调度等对策建议,以期推动计划生育政策在乡村进一步落实。     

A research on the assurance of family planning and providing for the aged]

An important cause of resistance to China's family planning (FP) program in rural areas is the need to have children to support parents in their old age. Provision of insurance for old age support will facilitate the implementation of the FP program among the rural population. A trial project was initiated in five cities and counties in Fujian province i 1986. The program included schemes for both eligible couples and for single children. The township or the village pays a lump sum or monthly premium to the insurance company for each couple, which enables them to collect 30-35 Yuan/month after they reach 55 years of age. To further expand the insurance program, a survey was conducted in 1987 to determine whether rural farmers would be willing and able to pay the insurance premium themselves. 77% of the respondents reported that they could afford to pay 60% of the premium. Among them, 59% were willing to pay. It was suggested that besides individual purchase of the insurance plan, the rural communities could contribute to the payment of the premium from the fines for unplanned births, from the local tax, and from the country government budget. Preferential treatment should be given to the couples of two daughters who receives sterilization; the communities should pay for a larger share of their premium. The current insurance scheme needs to be reformed so that the plan can offer more than the individual's bank savings. To do so, the insurance company needs to be able to invest their premium income and obtain higher returns. The employees of the insurance company need to improve their work efficiency to win the trust of the people in the program.     

Basic policies of the Philippine Population Program

This history of the Philippine Population Commission, which was created in 1969, is summarized. In 1970 President F.E. Marcos defined the government's task in this area as: 1) educating the people on the urgent need for population control; 2) disseminating knowledge on birth control techniques; and 3) providing facilities, especially in rural areas. Funding began in 1971. The 4 basic policies are noncoercion, integration, multiagency participation, and the partnership of the public and private sectors. The noncoercion policy means that all birth control techniques are offered and couples are free to use or reject whatever they wish. This has probably slowed the spread of family planning, but has also minimized opposition. Family planning has never been the domain of 1 agency but has been implemented through many agencies working together. Now it is being implemented through total community development plans, of which family planning is merely 1 component. This approach puts irrigation workers, agricultural development workers, and many others on the family planning team. private agencies have also had an important role to play in the development of the total program. For the past 5 years these have been mainly voluntary sociocivic and health associations whose interests are very close to or naturally related to family planning. Now the entry of business into the Population Program through the commercial contraceptive marketing program has enlarged the role of the private sector in the diffusion of family planning products and services. It is possible that the partnership between the public and private sectors may soon be based on segmentation of the target population with government agencies going deep into rural areas while private organizations concentrate on urban and adjacent rural areas.     

Economic development with limited supplies of family labor: Chinese peasant families in balancing demographic and economic requisites

Family planning (FP) in rural China, particularly the ramifications of the 1-child policy, has profound implications and ramifications for family-centered social and economic life in addition to demographic control. Under a constitutionally endorsed policy of strict birth control, favorable economic opportunities coexisted with the problem of familial labor shortages. Recent reform policies have led to a more relaxed FP environment. The Chinese state is in a dilemma between the need to allow peasant's autonomy in determining the familial work situation and the population pressure on the limited cultivated land. The Chinese experience of rural reform is examined in terms of the complex relationship between population change and economic development which are influenced by the production and welfare activities of the peasant family. The theoretical argument is that a family reliant strategy of economic reform undercuts the effectiveness of population control programs. The ultimate solution lies with sustained industrialization with high labor absorption. National trends and the Dahe People's Commune/Township experience are analyzed. Discussion is focused on the dilemma of FP and family production, old and new evidence of family size and economic performance, welfare outcome of family size, the role of the state in altering the demographic balance sheet, and the strategic response of peasant families to bring families of old designs back and urban migration and proletarianization. It is concluded that there is growing understanding that the causal relationships between population growth and economic development do not clearly support universal population control. Human social organization, not the man/land ratio, shapes the consequences of population growth. The implications for the Malthusian vs. Marxian debate for developing countries are that the resources/population imbalance needs to consider more carefully the human organizational factors. Mao's notions that a revolutionary transformation of the social organization of production in China would resolve overpopulation have since been rectified by opposing ideological positions: changing the basic mode of production through institutional decollectivization and checking population growth with the 1-child policy. This dilemma in rural areas translates to greater productivity and diversification with Chinese families having abundant adult labor and secured by the number of sons. It is difficult to substantiate the benefit of small families for peasants theoretically. Political rewards have been curtailed by economic declines. The peasant family has adapted by reconstituting old family forms and kin networks and by out-migration and nonagricultural employment.     

The differential effects and considerations of family planning programs in basic units]

It has been discovered that the grassroots units that did not well in family planning (FP) programs in China were short of funding, while those units that performed poorly had more funds at their disposal. One of the reasons is that communities which did a good job in FP have less violations of the birth policy, and therefore, fewer fines could be collected by the FP unit. But in those grassroots units were the FP policy was not well implemented, there were more cases of births exceeding the birth quota, and more fines could be collected. Such an outcome was penalizing the diligent and rewarding those who did not work hard. This phenomenon was caused by a severe short fall of funding for the FP program. The program budget allocated by the local government was only 1/5 of what was needed, the remaining part was to be provided by fines. The negative consequences of such a practice was damaging to the morale of FP workers. The following suggestions were make for solving the problem. First, the government budget allocation to the FP program should be increased, and part of the budget allocation should be determined by the performance of the FP program. Second, the spending of income from FP fines should be closely monitored to prevent misuse of the fund. Third, fine collection should not be used as means of income generation for the program, and not other agencies should reallocate the funds from fines. Fourth, the government and FP agencies at all administrative levels should pay attention to the management of funds from fines. FP organizations at higher levels should be able to reallocate the funds from fines collected by units with a poor performance to the units with good program performance as an incentive and to supplement their income.     

Village family planning: the Indonesian model

The goal of the Indonesian National Family Planning Program is to reduce the 1970 birthrate by 50% by the year 2000. Since the late 1960s the government has taken an active role in family planning. The National Family Planning Coordinating Board initially concentrated on offering family planning services through health clinics on Java and Bali, but, as of 1974, family planning has been expanded to 10 provinces in the outer islands. Early in 1975 the family planning program was extended to the village through the establishment of village contraceptive distribution centers and sub-village family planning groups. The experience generated from the initiation, development and evaluation of the village family planning scheme is useful in many aspects which may be adapted in other countries of the region. The guiding concepts of Java and Bali village family planning have been non-standardization, maintaining a link to the clinic in the movement to the village, and focusing 1st on contraceptive resupply. The following conclusions can be drawn on the basis of the Indonesian experience with village family planning: 1) family planning at the clinic level alone is insufficient in the long run; 2) the village must become involved in the process of providing services; 3) the enthusiasm and imaginative response to the movement in the village has exceeded expectations; and 4) rural people are, in fact, future oriented.     

Jiang Sannu's home clinic for family planning

Jiang Sannu, a physician in China's Jiang Jia Village (Shaanxi Province), opened a family planning clinic in her own home in March 1987 to increase accessibility to contraceptive supplies and information among rural couples. Jiang was the elected head of the village women's federation. During the day, Jiang Sannu travels door-to-door throughout the village, providing information on issues such as prenatal care, breastfeeding, and family planning policy and methods. She provides gynecologic and pediatric medical services as well as midwifery. The nearest maternity hospital is 2-3 kilometers from the village, so Jiang has to date delivered over 20 infants. In the evenings, she disseminates Communist Party Central Committee documents on family planning regulations through the village tweeter. There is widespread agreement among villagers that this family planning facility is well suited to the needs of the local community.     

Health worker pilot project

In a survey conducted by the Kavar Village Health Worker Project in Iran, among married women, aged 15-44, residing in 16 villages served by project trained, auxillary rural health workers, 28% used oral contraceptives, while only 13% of the women who resided in 16 control villages served by untrained rural midwives used oral contraceptives. Among women in the 25-35 age bracket, the % of oral contraceptive users in the project villages was twice as great as in the control villages. Surprisingly, despite the strong Muslim tradition extant in these villages, no significant differences in usage were found between those villages served by male auxillary health workers and those served by female workers. The auxillary health workers had been trained to provide a wide variety of preventive and curative medical services, in addition to providing family planning and contraceptive distribution. At the time of the survey, these workers had been serving the 16 villages for 21 months. In the 16 control villages the nonresident midwives had received no training but had been provided with oral contraceptives for distribution.     

A new terminal judgment method for family planning: indistinct comprehensive judgment]

The purpose of family planning (FP) program evaluation is to make comparisons between different work units and between the past and the present. The evaluation covers the impact of programs in economic, social, and demographic terms. If the impact is not quantified, it is difficult to distinguish differences in program performance. It is also hard to determine the relative standing of different organizations if each one has different merits and deficiencies. A mathematical model is used to quantify the performance of each unit in a FP program. 4 variables are used as the program indicators in the model: 1) percentage of child births following planning, 2) percentage of deferred marriages, 3) birth control prevalence, and 4) percentage of one child pledges. Indicators of social impact include 3 variables: 1) the attitude of FP workers, 2) the efforts of FP workers put in FP and 3) the results of program implementation. The indicator of economic impact is the investment for evasion of the birth of a child. Grades are assigned to indicators of social impact for each organization. The values of each variable is put in a matrix. Weights are given to each variable based on the emphasis of the program or a specific evaluation. The weights are determined through discussion with people involved in the program. A weighted average of all the above factors is the final grade of an organization's FP program performance.     

After the demographic transition: policy responses to low fertility in four Asian countries

In the low fertility countries of South Korea, Taiwan, Singapore, and Thailand, policy-makers are concerned about the consequences of low growth. In South Korea, a family planning (FP) program was instituted in the early 1960s, and fertility declined to 1.6 by 1987. Rural fertility is still higher at 1.96, and abortion rates are high. 32.2% of fertility reduction is accomplished through abortion. South Korean population will not stabilize until 2021, at 50.6 million people. The elderly are expected to increase and strain housing, energy, and land resources. Government support for FP is being reduced, while private sector services are being enhanced. Government sterilization programs have been reduced significantly, and revisions in the Medical Insurance Law will cover part of contraceptive cost. Integrated services are being established. Many argue for an emphasis on birth spacing, child and family development, sex education, and care of the elderly. In Taiwan, replacement level fertility was reached in 1983. Policy in 1992 recommended increasing fertility from 1.6 to 2.1. The aim was to stabilize population without pronatalist interventions. Regardless of policy decisions, population growth will continue over the next 40 years, and the extent of aging will increase. In Singapore since the 1960s, the national government focused on encouraging small families through fertility incentives, mass media campaigns, and easy access to FP services. Fertility declined to 1.4 in 1988. Since 1983, government has established a variety of pronatalist incentives. In 1989, fertility increased to 1.8. The pronatalist shift is viewed as not likely to succeed in dealing with the concern for an adequate work force to support the elderly and economic development. In Thailand, fertility declined the fastest to 2.4 in 1993. The key factors were rapid economic and social development, a supportive cultural setting, strong demand for fertility control, and a successful FP program. The goal is to reduce fertility to 1.2 by 1996. Replacement level may be reached in 2000 or 2005. Future trends are not clear.     

农村人口出生性别比偏高的原因及治理对策——以沂蒙山区BWZ村为例

本文通过在BWZ村的实地调查,主要是观察和访谈,发现当前农村人口出生性别比不断升高是当前的生育政策、传统的生育观念、村落文化和医疗技术的进步以及政府监管的漏洞等多方面因素共同作用的结果,提出了建立偏重纯女户家庭的养老保障、加强对B超检测技术的监管和提高村计生专职主任工资等可行性的建议。     

Massive drive to reenergize the family planning programme

A massive drive has been launched throughout India in an effort to reenergize the family planning program. The Prime Minister has made a special appeal to the nation from radio and television networks and through the press to adopt the small family norm as a way of life. The Chief Ministers and the Health Ministers in the States have made similar appeals to the people and the doctors. The current drive was preceded by 18 months of concentrated efforts to vitalize the family planning program. The change in nomenclature from "family planning" to "family welfare" created some misunderstanding regarding the government's own commitment to the program, but it is now widely understood that while family welfare aims at the total welfare of the family, family planning is an essential part of it. The government has tried to involve all sectors of society in program efforts. The mass media is now focusing attention on "family welfare" almost continuously. In villages, a large-scale program of organizing education camps of opinion leaders is now underway. The rural health scheme, initiated in October 1977, promises to bring about increased participation of the people in village programs. 54,000 community health workers have already started serving the rural population in their areas. In 2-3 years there will be 1 trained community health worker in every Indian village.     

The construction of the fertility model of variable parity from family planning practice]

Understanding the changing patterns of age specific fertility under the planning system is essential for building a fertility model which reflects birth control policy implementation in China. In building a Parity Variable Fertility Model, 4 basic elements are to be considered: 1) psychosocial, and physiological variables, 2) patterns of the total fertility rate and age-specific fertility rate, 3) socioeconomic development, and 4) distribution of parity-specific fertility. THe natural fertility of women is 17, calculated from a 309-years childbearing period, with 17% of non-susceptible time. In China, about 86% of natural fertility is suppressed by various factors. In this model, the following variables are included: 1) The first marriage ratio, which is the proportion of women in each age group which enters into a first marriage. The range and spread of this ratio is closely associated with the first birth. 2) The first birth ratio, which is the proportion of a marriage cohort to have a first birth each year. 3) the birth interval, which determines the distribution of second births. 4) Regulation coefficient B, which represents birth control regulations which approximately determine the number of second-parity or higher order births. The difference between the fertility level generated from the Parity Variable Fertility Model and reality depends on the implementation of birth control program, the assumptions on regulation coefficients, and changes in social and cultural factors. The model is easy to use, especially for areas where the marriage and fertility records of women of child-bearing are well kept.     

Promoting family planning work in Xiaqidu township by establishing a family planning association in each village]

A family planning association was established in each village of Xiaqidu Township in Hunan Province, China in October 1986. The positive functions of each such association were so fully developed that family planning work reached new levels. For example, most villages are no longer experiencing early marriages or unplanned births. Some of the villages have established associations for individual work groups. The traditional method was for both township and village associations to rely upon the positive attitudes of officials to instill into fertile women Party policy, and to arouse their patriotism and initiative. By establishing family planning associations at the village level, however, the people can conduct their own affairs and educate themselves. Emphasis has been placed on attracting into the associations those who are of childbearing age, as well as older villagers of experience. The associations' raison d'etre was to serve the people. They did so through: propaganda (disseminating population theory, birth control and family planning information); helping the people overcome poverty, traditional thinking, and ignorance; assisting women with any problems and anxieties relating to child-bearing; delivering contraceptives to households; and providing the elderly with care and the young with education.     

More choices of birth control approaches

In rural Zhejiang Province, China, family planning intermediaries are appointed for each village to introduce comprehensive measures of birth control to the people. With an education level of junior middle school at least, they are mostly working women of high prestige in their villages. After appointment as intermediaries, these women are trained for 1-2 weeks in health stations or maternal and child health care stations in towns. Back in the villages, they take over responsibility for distributing monthly contraceptives as needed by women of childbearing age. The intermediaries also explain the advantages and disadvantages of different kinds of contraceptives to newly wedded women and give them guidance and recommendations. Intermediaries also can provide simple treatment for complaints caused by contraceptive use. For example, if women complain of nausea while 1st taking oral contraceptives (OCs), the intermediaries will give them vitamin B6. When intermediairies encounter difficulties, such as women who cannot use OCs for a long time because of a liver ailment, they refer the people to health stations or send for a doctor. The number of induced abortions has declined because of the fact that a vast number of women of childbearing age in rural areas now obtain appropriate contraceptives in time. Generally, each intermediary is assigned to be in charge of 15-20 households, making a regular monthly visit to each of these families. The contraceptives they distribute are from town governments, which give them a certain amount of annual subsidies.