Family Planning and Women's Lives in Rural China

In the 1950s, China's Chairman Mao Zedong rejected the need for family planning programs, saying that China needed more labor power.¹ However, by 1979, China had begun implementing the world's most stringent antifertility policy and program, which amounted to an assault on China's system of gender norms and roles. The policy, which limited most couples to one child, was justified on the grounds that China could grow economically only if population growth were held in check.² In addressing the conflict between the so-called one-child policy and a society that valued males over females, the government noted that "feudal thinking" leading to son preference would change as a result of economic growth and the implementation of a system for old-age security.³

Family planning was available only in some urban areas in the 1950s. During the Cultural Revolution, which extended from the mid-1960s through the mid-1970s, family planning received little attention and was not widely implemented. A "later-longer-fewer" (wan xi shao) policy—designed to encourage later childbearing, more widely spaced births and fewer births—was instituted in the mid-1970s, but was more widely implemented in some provinces than in others. Since 1979, China has implemented the one-child policy, although the government has never sought to limit all couples to only one child. Over the years, the policy has included a number of exceptions that allow some couples to have larger families: For example, couples belonging to ethnic minorities and couples living in rural areas whose first child is a daughter typically have been allowed to have more than one child.⁴* The one-child policy has been most strictly implemented in urban areas and in semiurban areas in prosperous provinces.

As a result of the one-child policy, a strong family planning program and overall socioeconomic changes, China has experienced a rapid decline in fertility, particularly in urban areas. The country's total fertility rate fell from more than six children in the 1950s to approximately two in 1992,⁵ and continued to fall throughout the 1990s. A number of studies, however, show that China's population policy conflicts with a culture that values males over females⁶ and therefore exacerbates the effects of son preference, particularly in rural, agricultural areas.⁷

The generations of Chinese women alive today have lived in a rapidly changing country and have experienced family planning very differently than those in previous generations. Whereas older women had little or no access to family planning, and middle-aged women were abruptly compelled to curtail their childbearing in adherence to the government's goal of rapid fertility decline, younger women have grown up with the one-child policy as part of their lives. How do Chinese women perceive their lives to have been affected by the one-child policy and family planning? And do they feel that family planning has contributed to gender equity or changing gender norms?

This article is based on a study that was unique in China, in that it was the first international collaboration with the explicit goal of studying the effects of family planning on women's lives. Other studies have examined China's family planning program and people's reactions to it; however, this was the first study on the subject sanctioned directly by the State Family Planning Commission and conducted by a government research organization in collaboration with an international organization. It was implemented at a time when the government was acknowledging that the one-child policy might have some negative effects, such as skewed sex ratios resulting from the combination of son preference and low fertility.⁸

Using survey statistics and excerpts from focus group discussions among rural women in three Chinese provinces, we examine links between family planning and childbearing and women's lives within the family, including their relationships with spouses and other family members, and their opportunities for education, employment and social activities.

METHODS

Data

We used data from a study conducted in 1996 and 1998 by the China Population Information and Research Center (CPIRC) and the Women's Studies Project of Family Health International.⁹ The study was carried out in two rural counties in each of three provinces: Jiangsu, Anhui and Yunnan. The three provinces differ economically and by the level of success of the family planning program, and although they do not represent all of rural China, they do offer a range of areas with widely differing conditions.

Jiangsu, on the eastern coast, has a rapidly growing economy that relies only partly on agriculture. Although all the study sites were officially classified by the Chinese government as rural, the two counties in Jiangsu are "rural-urbanized," or formerly rural areas that have become urban. Both were recently ranked in the top 100 counties in China in terms of economic growth. One county is known for its embroidery, but also has family and household industries; the other has a strong industrial base and includes national demonstration models of modernized rural townships. Jiangsu, which has strictly enforced the one-child policy (with exceptions) since 1979, is in the highest of three levels for family planning performance (in terms of both contraceptive prevalence and the total fertility rate) in the country.

Compared with Jiangsu, the central province of Anhui is more agrarian and less prosperous, and the two counties in north Anhui choosen for the study are considered poor, even by Anhui's standards. Both are predominantly agricultural: One is known for producing wine and herbs, and the other for producing plastic string. Anhui is considered in the second tier of provinces for family planning performance. Since the mid-1980s, family planning policy has been somewhat strictly enforced in Anhui, with couples whose first child is a son being prohibited from having a second child (sometimes referred to as the "daughter-only" policy).

Yunnan, in western China, is agrarian and has strong trading ties with Vietnam, Laos and Cambodia, with which it shares borders. Economically, Yunnan is similar to Anhui in that they are both agrarian. Culturally, however, it differs from both Anhui and Jiangsu. Yunnan is home to a number of national minority groups,* some of whom have a tradition of daughter preference. The fertility policy in Yunnan is more relaxed than in the other two provinces: Han couples are allowed to have one or sometimes two children, whereas minority couples are allowed two (with a four-year interval between the two children). The level and quality of services is not as good as in Jiangsu and Anhui, even though Yunnan receives a substantial amount of international family planning and reproductive health assistance.

Overall, 4,501 women and 1,526 men were interviewed in the survey; 32 women and 232 men participated in focus groups that ranged from five to 12 people. The focus groups were conducted with women and men of reproductive age, women and men past reproductive age, unmarried women and male and female entrepreneurs (a group of special interest in China). The fieldwork in Jiangsu and Anhui was carried out in 1996; because of funding issues, fieldwork in Yunnan took place in 1998. Given that the family planning policies and the social and economic situation in the three study sites remained the same during this time, the difference in the timing of the fieldwork should not affect the results.

CPIRC and the provincial and local family planning commissions chose two counties for the study from each of the three study provinces. Within each county, 10 townships were randomly selected for the survey and seven townships were randomly selected for the focus group discussions. CPIRC randomly selected one administration village (which includes several natural villages) from each township, with the requirement that the village be at least three kilometers away from a town. From each village, 120 households were randomly selected from lists of couples of reproductive age maintained by local family planning workers.

During the field survey, CPIRC interviewers were permitted to visit only the households on the list. If no one was home when the interviewer visited, the interviewer was instructed to go to the next house on the list. When 75 ever-married women and 25 ever-married men from the list had been interviewed, the survey in the village was considered finished. If a sufficient number of interviews could not be conducted in a village, the interviewer was instructed to go to a nearby village to complete the interviews. Although response rates were not calculated, the people approached in the eligible households were very likely to agree to participate; thus, overall response rates were very high.

In one county in Jiangsu, interviewers surveyed some men and women at work instead of in their homes, because most couples worked in factories during the day. More respondents in that county than in others had to be substituted; thus, the sample from that county became a convenience sample. The sample is slightly older in that county than in others because many of the younger women were working in the township. Still, most of the women interviewed in the county had one child—the same number women not interviewed likely had.¹⁰ Thus, this difference in sampling had little effect on the analysis.

For the focus group discussions, local leaders helped select participants after discussions with the research team on the desired characteristics of participants. The groups, which met in various public places, lasted 1-2 hours and were moderated by CPIRC staff. Separate sessions were held with women and men, and with different age-groups. Although it would have been ideal for the moderator to be similar to the group, particularly in terms of sex and age, this was not always possible. In addition, a local representative was present to translate, if necessary. Some groups were observed by officials from the township or province, but these observers were not known by the participants.

Data Analysis

For our analyses, we used survey and focus group data from women only. Survey data were entered and analyzed using SAS and SPSS statistical packages. Transcripts from the focus groups were typed in Chinese and translated into English. The authors analyzed the focus group data by reading the transcripts and identifying themes and representative quotes. In this article, tables with descriptive statistics refer to results of the survey of women and quotations are from the focus groups with women.

We acknowledge that this study was conducted in a social context in which people are generally not inclined to criticize government policies and programs, especially one as important as China's family planning program. The survey participants were chosen at random and were interviewed alone; however, as in research settings in other countries, answers to the questions posed in the study may reflect what women thought the government would want to hear. It is also possible that the family planning program has been operational for so long that women have internalized the messages that family planning and the small family norm are good, and that family planning must therefore be beneficial to people's lives. Still, not everyone in the study spoke favorably about family planning, so participants must have felt they had some leeway to be critical.

We recognize particularly that the method of choosing focus group participants likely introduced some bias into the findings; however, such involvement by the government is a reality of doing most research in China. The participants in the focus groups probably do not include the women with the most negative perceptions of family planning. Still, the results show diversity of opinion and a number of negative comments, suggesting that those who did participate felt at least somewhat free to give voice to their feelings.

RESULTS

Sample Characteristics

The women in the survey were aged 20-55, with an average age of 35.5 in Jiangsu, 33.0 in Anhui and 32.8 in Yunnan (). Virtually all of the women were married (not shown); the mean age at marriage ranged from 21.4 in Yunnan to 23.6 in Jiangsu. Educational attainment differed across the three provinces: Two percent of women in Jiangsu had no education, compared with 7% in Yunnan and 37% in Anhui. The greatest proportion of women in Jiangsu (58%) had had a middle school education, whereas the greatest proportions in Anhui (42%) and Yunnan (57%) had had a primary school education. At least 90% of women in Anhui and Yunnan were farmers, whereas only 21% of women in Jiangsu worked in agriculture. In Jiangsu, the greatest proportion of women reported working in a local enterprise (62%). In 1995, the average family income in Jiangsu was about 20,000 yuan (US$1≈8.3 yuan), substantially higher than the average family income in Anhui (4,500 yuan); in 1997, the average family income in Yunnan was 5,700 yuan (not shown). The differences in local policies are evident in the childbearing statistics: The average number of live births was 1.3 in Jiangsu, 1.8 in Anhui and 2.1 in Yunnan.

Experience with Birth Control

•Contraceptive use and parity. Use of contraceptives is required in China. Couples with one child are directed to use the IUD and those with two or more are expected to be sterilized. Although the government is experimenting with allowing women more method choices, the IUD and sterilization continue to be the two most prescribed and used methods. The vast majority of women in Yunnan (87%), Anhui (91%) and Jiangsu (97%) reported that they (or their partners) were currently using a contraceptive method (); 90-96% of those who reported using a method were relying on the IUD or sterilization. In each province, the contraceptive use pattern corresponded to the fertility level. In Jiangsu, most couples had one child and thus used the IUD. In Anhui and Yunnan, a greater proportion of couples had two children, and contraceptive use was split between the IUD and sterilization. On average, women reported that they had been using their current method between 5.7 and 9.7 years.

•Contraceptive failure. A greater proportion of women in Jiangsu (29%) than in Yunnan (9%) or Anhui (12%) reported having had a pregnancy as a result of contraceptive failure (not shown).^† These differences are not surprising, as a greater proportion of women in Jiangsu used the IUD, whereas greater proportions of women in the other two provinces relied on sterilization.

•Experience with family planning. In the focus group discussions, women of various ages described their experiences with family planning generally and with specific contraceptive methods. Typically, older women said they wished they had had better access to family planning and talked about the number of children they would have had if they had been able to use contraceptives. A 60-year-old woman from Anhui who had five children said, "Now young people are so happy—they have family planning. At that time, we didn't want to make more children but we had no family planning methods."

Many women recounted IUD failures and the abortions they had as a result. They mentioned that the steel ring IUD—widely used until recently—had a propensity for dropping out. A 28-year-old Jiangsu woman with one son said, "I had a C-section. After the baby was taken out, they put in an IUD immediately. Last month [one year after insertion], I had a contraceptive failure. I took medicine and had an abortion." A 34-year-old woman from Yunnan who has two daughters joked, "I never heard about anyone who was not worried [about the IUD]." Thus, women worried about becoming pregnant even when practicing contraception, and many had to terminate unplanned pregnancies.

Interestingly, use of male contraceptive methods was more common at the beginning of China's population program than today. No one in the focus groups said that men should now be taking on more of the burden of contraception. In fact, even though women said they did the bulk of the hard agricultural labor, many of them said that women should be sterilized rather than men in case there were side effects that would cause the family to lose men's labor power.

Even so, participants in both Anhui and Yunnan remarked on people's unease about accepting sterilization, even after two children. A 25-year-old woman from Anhui who did not yet have children said, "Sometimes when the baby is born, it is as normal as others. But maybe three to four years later, the problem shows up because the child can't walk or talk. If a couple is sterilized but they are both healthy, how can they deal with this?" A 36-year-old woman from Yunnan who had two sons and a daughter gave a variety of reasons why women do not like sterilization: "If we use sterilization, maybe we will worry about the husband's morality [that the husband will find another woman and get divorced]. The family will be broken. After divorce and remarriage, the woman will need to have a baby. Also, our work is heavy, and sterilization is not good for health. It might cause a backache."

The youngest women had not had experience with contraceptive use, but in their focus group discussions did talk about how they received information on reproductive health. A 20-year-old woman from Anhui explained, "Usually after marriage, your mother and mother-in-law will talk to you about this stuff. They will talk about the disadvantages of early and more childbearing from the point of view of women's health care. If you have more children, you will become a baby-making machine and will get old very quickly." A 21-year-old unmarried woman from Yunnan agreed: "The IEC [information, education and communication] in family planning doesn't focus on us. But we of this generation know that more children means more load on the family. We in this room don't want more children."

Number and Sex of Children

•Satisfaction with the number and sex of children. Because childbearing is severely constrained in China, gender preference is acutely apparent. Sex preference reflects attitudes towards gender norms and the perceived relative value of males and females. We have seen that the women in the nonagricultural areas of Jiangsu are increasingly becoming economically active by working in local enterprises, whereas women in Anhui and Yunnan are still primarily engaged in agricultural work. Women in all three areas continue to bear the primary responsibility for household activities, including child care and housework. At the same time, families in Jiangsu and Anhui whose first child is a son have been limited to one child, and families in Yunnan and Anhui whose first child is a daughter have been limited to two children. Here we look at the value placed on sons and daughters as measured by women's satisfaction with the sex of their children.

About three-quarters (73-75%) of respondents from Jiangsu were satisfied with one child, regardless of sex ().^‡ In Anhui and Yunnan, more than half (54-58%) of women who had one son and no daughter reported being satisfied with their number of children, compared with 31-50% of women who had one daughter and no sons. The great majority (73-99%) of women in all three provinces who had either a son and a daughter or two daughters were satisfied with their number of children; the most satisfied were those who had one son and one daughter (93-99%). Interestingly, respondents with two daughters reported higher levels of satisfaction than did those with one child, regardless of sex. Respondents who were not satisfied tended to say they had too few rather than too many children.

•Sex preference. Son preference was most evident among the older women. A 45-year-old woman from Yunnan with one son and one daughter indicated that grandparents perpetuate gender inequality by treating their grandsons and granddaughters differently. "Mothers-in-law love their sons and grandsons, but not their daughters. If a grandson isn't back home on time, the grandmother will worry. If he is sick, she will bring him to the hospital. If it is the granddaughter, no. Our generation treats girls and boys equal. But there is a common sentence in the village: boys are treasure, girls are trouble." One just-married 25-year-old woman from Anhui with no children wants a son, even though she says she should not feel that way: "If I don't get a son, I will consider that my fate is bad. I am a graduate of senior high school, but I still think boys are better. Of course, if I have a daughter, I will love her. At home, my mother and grandmother think it's bad to have a daughter. Most people think if you have no son, you will still want another [child]. If you only have a daughter at home, you are considered incapable. That is stupid, but people in villages think that way."

Some couples will do anything to make sure the second child is a boy; most rely on ultrasound machines, even though it is illegal to use them to reveal the sex of a fetus. According to one 47-year-old woman from Anhui who has two sons: "People use an ultrasound B machine. If it is a female fetus, they don't want it. People will usually go elsewhere to check. No matter how much money they have to spend, they think it is worth it."

Some respondents said having daughters was better than having sons. Their reasons were mainly economic, but also social: They argue that daughters take better care of their parents and are nicer and easier to raise. A 64-year-old woman from Yunnan who has five sons and one daughter noted that girls are better behaved and less expensive than boys, but that in her day, it was essential to have a son. "Boys spend more money than girls. They smoke, drink and play mahjong. But girls listen. Families have to help boys marry. That costs 10,000 yuan. But girls only need a little dowry. Give them 2,000-3,000 and let them go away." A 35-year-old woman from Jiangsu who had one son said, "When a girl grows up, she can learn to embroider and make money. In my village, girls don't worry about jobs—they pick up the needle."

A 22-year-old woman from Jiangsu said that the desire for sons is strong where she lives because couples are allowed only one child, but that she does not share that view. "If a family has only one daughter, it is unlikely that they will feel comfortable. If the social environment were sound, it might not matter. In my eyes, after having a daughter, having a son is evidence of discrimination." A 25-year-old woman from Anhui noted, "Whatever men can do, we can do. You know women hold up half the sky. It is not just boys who are the sun." A 22-year-old woman from Yunnan agreed. "Before there was strong son preference, but now there is family planning and whatever you have you just have." Only a few people mentioned the problem China's skewed sex ratio will cause young men as they try to get married. However, a 35-year-old woman from Jiangsu who has one son said, "If everyone has sons, it will be difficult to find a wife."

Family Planning and Women's Roles

In the survey, we asked women if, in general, they thought family planning had had a favorable effect on their health, household work, education, opportunities for and time at a job, ability to earn more income and time for leisure. Women, particularly in Jiangsu, expressed very favorable opinions of the effect of family planning on their lives. More than 95% of women in Jiangsu felt that because of family planning they were healthier, had less household work, had more time to work or more job opportunities, and could earn more money (); 82-84% believed that they could get a better education and had more leisure time. Although the majority of women in Anhui and Yunnan also perceived these benefits, smaller proportions than in Jiangsu believed family planning had positive effects on education, job opportunities and leisure.

In seeking to understand the link women made between family planning (and childbearing) and women's roles, we asked focus group participants to describe women's roles in the family, in economic activities and in the community. They were then asked to relate those roles to family planning and to childbearing. Many women made direct links between family planning, having fewer children and improvements in their lives, corroborating the findings from the survey. Successive generations of women have played different economic roles in the three provinces, yet their familial roles have changed little over the years. Younger women have had more opportunities to obtain an education and to work for income.

•Employment and Economic Opportunities. A 70-year-old Jiangsu woman who has five children said her life would have been different if she had had access to family planning: "I used to be a primary school teacher. After having three children, I couldn't participate in any social activities. After work, I could only care for my children. I'd have to take my children to work. If family planning had been available earlier, my life would have been different. That is my lifelong regret. Because I had too many children, I had to quit." According to a 44-year-old woman from Jiangsu who has one daughter, "Women's status is higher now, of course. In the past, women couldn't work outside the home. Women of my age all have jobs."

A 34-year-old woman from Anhui who has one son and one daughter said, "We have fewer children, enough to eat and we can go where we want to. My husband works in the fields on cash crops. I go out to sell plastic string in three provinces. Women often go out now, so people don't say bad things about them. Women are even respected and considered capable." A 35-year-old woman from Yunnan with one son and one daughter said, "For family affairs, raising children and the family economy, family planning is all good."

In China's collective economic period, which lasted through the 1980s, all agricultural work was carried out by work teams whose members were paid the same, regardless of their contribution. One important measure of inequality was built into the payment system: men earned 10 work points to women's eight. Some women in this study said that women and men can now earn equal pay for equal work, if they can get equal work; according to others, however, the legacy of the work point system remains. A 36-year-old woman with one daughter from Jiangsu said, "I work in a factory where the work requires a lot of difficult and heavy work (dying textiles). The women should get equal pay for equal work. The top workers are posted on the wall—most are male. Women work more and enjoy less." According to a 42-year-old female school principal from Jiangsu who has one son, "Women's status has improved. When it comes time for bonuses and promotions...I don't see men way ahead and women behind in my school. It is not necessarily true that women's achievements are less than men's." A 21-year-old woman from Yunnan believed that women still face discrimination: "In education and occupations, there is still discrimination against girls. It is easy for men to find a job but not for women, even with the same education. In the same unit, men and women have different salaries. Men can work hard at night, but women cannot do heavy jobs. In some work units, they think women can only clean the floors and tables."

Rather than wanting more children, women said people now place a priority on how they can make money to provide better housing and education for their children, particularly their sons. A 29-year-old mother of one son from Anhui noted the custom of helping to provide sons with housing: "I have to work more to make more money for my son. I have to build a house for him and his wife and save for myself for when I'm old." A 44-year-old woman from Jiangsu who has one daughter said "I work in a factory [and make] a good living. I cannot care for more children. If I have more children, my living standard will go down, which won't be good. The children will compete for things like clothes. When I married, I could have two children, but since my family was poor, I only had one. Supporting one child through school is the same amount of money as constructing a cottage. I want better clothes and food."

•Decision-making. Increasingly, women are becoming more equal in household decision-making, according to focus group participants of all ages and from all three provinces. A 40-year-old Jiangsu woman who has one son and has worked as an embroiderer for more than 10 years reported earning more money than her husband. She said, "My position is equal to my husband's. I can spend money and discuss with my husband. My parents' generation fought because they were poor." A 37-year-old woman from Yunnan with two daughters also noted the change in women's roles in the family. She said, "In the past, daughters-in-law had the right only to suffer, not the right to speak. Usually the daughter-in-law is an outsider. In the past she could not participate in making family decisions. Now she can discuss things openly in the family."

Social Welfare Benefits and Old Age Support

Old age support in China has traditionally been the responsibility of families (and particularly sons), but also fell to communities and work units under the collective system. Elderly people without adult children were cared for by the collective with the "five guarantees": food, housing, clothing, health care and burial expenses. Partly in response to the smaller family size caused by the population policy and to the dismantling of the collective system, the government is trying to extend social welfare benefits—particularly old age insurance—to more citizens; present coverage is available only for residents employed in jobs in the formal sector.¹¹

Among the survey respondents, workers in the formal sector received social welfare benefits not available to agricultural workers, including paid sick leave; maternity leave; old age, health, life, hazard and disability insurance; and a housing allowance. Analysis of the social welfare benefits received by women shows enormous differences by geographic area: Much greater proportions of women in Jiangsu (23-73%) than of those in the other two provinces (1-20%) received social welfare benefits (). Women in Anhui and Yunnan were virtually unprotected by many social welfare benefits.

Roughly similar proportions of women in the three provinces were concerned about being supported in their old age (not shown). It is surprising that a greater proportion of women in Yunnan (32%) than in Anhui (22%) reported being worried about support in their old age, given that a greater proportion of women in Yunnan reported receiving old age support insurance and the average family income was higher. The vast majority of women (86-95%) expected to live with their spouse when they were old; 47-56% believed they would live with their son, whereas 9-34% thought they would live with their daughter.

In the focus groups, several women talked about the help elderly people without children can expect through the "five guarantees," which continue to be provided by the local government even after the dismantling of the collective system. A 54-year-old woman from Anhui with one son and two daughters explained, "There is no problem with childless men and women late in life. If they have no children, they go to the government. When there is a festival, the government will come to look after us [so that we] have something to eat. In winter and summer, we have clothes. The cadres bring water and food to my house. If I'm too old to move around, they will bring it to my doorstep." A 46-year-old woman from Yunnan with two sons and a daughter agreed, saying "We are not worried about getting old. Every family takes care of its 'face,' so families will compete with each other to treat their parents best. If they have no son or daughter, the village will care for them."

And although care facilities for the elderly exist in China, some younger people said that they are negatively viewed within the rural culture. One 25-year-old married woman from Anhui who does not yet have children said, "You may go to an elderly home, but you will lose face. If you have children and go to an elderly house, people will still laugh." A 55-year-old woman in Anhui who has a son and a daughter echoed many people's worries about who would be around for old-age support. "Family planning is more acceptable now in rural areas. [But] if we get sick, no one will take care of us. Later when we are old, there will be no one to look after us. We need elderly homes, but the key is the economy."

DISCUSSION

The meaning of family planning is different for each of the three generations of Chinese women studied in this article. Older women typically had more children than they wanted and regretted not having had better access to contraceptive services. Middle-aged women were not adverse to the idea of having fewer children when the one-child policy was first implemented (as evidenced by the fact that fertility rates had already begun to fall in the 1970s), although, at the time, they were not necessarily ready to be told how many children they were permitted to have. And young women, who have lived with the one-child policy all their lives, seemed reconciled to having few children. However, regardless of which generation they are a part of, women have all felt pressure to have sons.

Women did not view family planning in a vacuum, but related it to the country's economic situation. Even within the very different economic and social contexts of the three provinces, women saw family planning as a means of helping women (and men) take advantage of China's improved economic situation by not being tied down or having too many children to feed and clothe. Overall, the women in our study felt positive about having smaller families, believing that family planning has enabled them to get ahead economically. They now have the ability to focus on earning money for the family, and particularly for children's schooling and housing for sons.

Has family planning had an effect on China's gender system? Ding Ling, one of China's most famous feminist writers, noted in the early 1940s that "The party has proclaimed lofty theories of gender equality, but failed to deal with the actual conditions and attitudes that held women in an inferior condition."¹² In our study, few women disputed that women's lives were better now than in the past; however, we found evidence that an entrenched gender system favors males and that constraining couples' childbearing has exacerbated the effects of son preference.

These findings are supported by Chinese feminists who generally note that family planning has had beneficial effects on women's lives but has not been sufficient to change gender norms.¹³ In China, females are less likely to be born, and even to survive.¹⁴* Women in rural areas do not carry on the family line and do not inherit property. They leave home after marriage, work and carry the burden of taking care of their children and household, in addition to taking almost sole responsibility for family planning. China's skewed sex ratio provides strong continued evidence of the entrenched social valuing of sons over daughters.

However, our results show some signs of change. Over the past two decades, some women have had wider opportunities to work. Because of the increased economic contribution of women, decision-making within families may be becoming more of a joint endeavor, and younger focus group participants from each province noted that the preference for sons is decreasing (although not disappearing) among their generation. In addition, as agriculture becomes more mechanized, families' need for sons should decrease.

Program Implications

Our study found that although women by and large welcome the idea of family planning, they have not always received good care by their local program. Following the 1994 International Conference on Population and Development in Cairo and the 1995 Fourth World Conference on Women in Beijing, China began shifting its program toward a client-centered approach to family planning and reproductive health. The program, which started as a pilot project and has expanded to more than 32 counties, now provides better quality care and a choice among contraceptive methods, in addition to an expanded range of reproductive health services.¹⁵ China is ready to expand the client-centered and quality-focused approach to more rural counties and urban districts to meet the State Population and Family Planning Commission's goal of completing the nationwide reorientation of the program by 2010. The 2000 (once a decade) decision on the future of the population program and the 2001 Population and Family Planning Law of the People's Republic of China¹⁶ both affirm this new client orientation—albeit within a policy context affirming strict control over fertility.

Although these changes in the orientation of China's family planning program are encouraging, our study shows that in addition to improving the quality of family planning and reproductive health services, the government and society must address the roots of gender discrimination by promoting gender equity through policies and programs, and by enforcing laws that protect women's rights.

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Karen Hardee is director of research, POLICY Project, The Futures Group. Zhenming Xie is senior researcher and deputy director, China Population Information and Research Center, Beijing. Baochang Gu is deputy executive director and director for international cooperation, China Family Planning Association, Beijing.