Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Rose-tinted spectacles
- Vaughan P Smith (22 August 2006)
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China’s one-child policy: pseudo economic rationalizations
- Meng-Kin Lim (24 August 2006)
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Population Control
- Anthony D Clift (25 August 2006)
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Not a policy to emulate
- Cameron B McLarty (26 August 2006)
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Policy or a disaster?
- Aruna Reddy Gurrala, Chandrakant Gosavi (29 August 2006)
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Rapid population redoubling
- James G. Danaher (1 September 2006)
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World population growth - the biggest challenge to public health and the environment
- Rachel Joyce (3 September 2006)
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Speak up for those who cannot speak for themselves
- Gregory Gardner (3 October 2006)
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One word of truth...
- Gregory Gardner (3 October 2006)
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Vaughan P Smith, General Practitioner Taunton TA2 7SZ
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You can't separate Politics from Medicine. But the trouble is that in any editorial, the greater the ratio of Politics to Medicine, the harder it is to maintain the level of neutrality and objectivity that we have the right to expect from a journal of the stature of the BMJ. Professor Potts' editorial (BMJ 19/8/06 p361) exemplifies this point clearly. The ratio of Politics to Medicine is high, but the objectivity, with respect, is low. In my opinion he overplays the benefits of China's one-child policy, and greatly underplays its drawbacks (late abortion, infanticide, and gross interference of an unelected government in the affairs of private citizens). In effect, Potts was saying that the benefits outweigh the drawbacks, or the end justifies the means. At one point he said that "a falling birth rate offers a demographic dividend, as the economically productive proportion of the population grows more rapidly than the general population." As a doctor reading his BMJ, and as an epidemiological simpleton, I would like this point to have been explained more thoroughly, especially as it seems to conflict with his later point that "when birth rates fall rapidly, during their most productive years the younger generation needs to support a high ratio of old people." When Professor Potts came closest to acknowledging the political controversy that surrounds the one-child policy, he unfortunately couldn't resist a bit of Bush-bashing. Why is the US government described as the "Bush administration" while its Chinese counterpart is called, not the "Hu administration" but simply "China"? At least Bush, unlike Hu, was elected by his citizens. And why is the US public criticism of the one-child policy said to come from "a veritable media industry"? What about Chinese public criticism of the policy? Oops, sorry, I forgot. The author goes on to tell us that people in countries that fail to control their populations will either starve or be dependent on Western humanitarian aid. China, in contrast, "reaches out to help other countries". It was therefore surprising to read, a few pages further on in the BMJ, that the UK government is to donate £30 million to China to help its HIV/AIDS programme (BMJ 19/8/06 p368). Finally Professor Potts praises "the sacrifices the Chinese people made to implement the one-child policy". I wish he had discussed the extent to which their sacrifice was voluntary. And I wonder if the concept of "sacrifice" is too sanitised, and whether he had considered alternative words such as "anguish" or "despotism"? Competing interests: None declared |
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Meng-Kin Lim, Associate Professor Yong Loo Lin School of Medicine, National University of Singapore
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Potts (BMJ 19 Aug p361) is right about rapid population growth being an “unforgiving task master”, but wrong when it comes to the “demographic dividend” that China is purportedly reaping from its one-child policy. True, any initial improvement in the dependency ratio is good for the country, but what happens when the whole generation of children grows up? There will be only one adult supporting two aging parents and four aged grandparents. In China, this is dubbed the "One-Two-Four" problem, the recognition of which has resulted in relaxation of the rules in some areas, under certain circumstances. To be fair, population control measures are necessary and well-intended, and the problems encountered in implementation, including sex-selective abortion and infanticide, are not unique to China. But I shudder to think of holding up the harsh Chinese model for others to emulate, as Potts goes on to suggest. If moral suasion and international opprobrium cannot bring an end to perverse practices, the least that the experts could do is refrain from offering pseudo economic rationalizations that justify their perpetration. Competing interests: None declared |
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Anthony D Clift, General practitioner retired 151 Manchester Old Rd Middleton, Manchester M24 4DZ
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Chinas one child policy 19/8/06 Dear Sir/Madam Your editorial by Malcolm Potts is an undisguised apologia for population control. At least he notes that such policies are anathema to many in the USA, which still apparently enshrines individuals rights in family matters. I don’t claim economic expertise but perhaps the overpopulation argument is flawed. I note that in Russia, which in the past promoted population control, there are major concerns for the nations economy, following a shortage of skilled workers (recent news item), and the government is pleading with couples to have more children. Moreover we don’t need to look far to see that in our own country, and medicine and nursing are prime examples, we are highly dependent on immigrant labour. Historically Britain developed as a world power in the 19th century parallel with the development of a burgeoning indigenous population and some immigration, mainly from Ireland, and after the various dispersions in Europe. It sometimes seems that the sacred cow of contraception and its fallback of abortion has become an obsession with our profession, and I doubt the appropriateness of using the BMJ or the NHS to encourage this kind of thing. It has always been a puzzle that contraception has remained free to all in the UK (one of the only free prescriptions) even when our services are strapped for cash. Surely people can sort out their own decisions in this matter. It is possible that when populations become used to having few children, the urge to procreate may become even less, for a variety of reasons, not least as couples become scared by injudicious newspaper comments about the huge cost of bringing up a child. We may see the beginnings of a national decline. Paradoxically we note various efforts to produce children artificially, as if everyone, even the unmarried, seems to feel they have a right to a child, rather than seeing children as the natural result of marriage. It’s a funny old world. How did I, as a GP in a poor Northern mill town when GPs salary was small compared to the present, manage to steer our 12 children through school, university, and into various professions, including our own? Could it be that I had a stable marriage with a wife who was prepared to play her role not just in childbirth, but also in the curious, if difficult art of bringing up children. Despite (or because of this) she still managed to take part in numerous public activities especially in educational areas. Isn’t it time for doctors to stick to their trade and avoid patronising families in the matter of fertility. Yours sincerely Anthony Clift MD FRCGP Competing interests: None declared |
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Cameron B McLarty, Student Greenock, PA16 9AW
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I found Professor Potts’ editorial and research (BMJ 19/8/06) to be sad reading. The “One Child Policy” is a tragedy, and should be condemned as such. It has caused far more than “great individual pain” - it has ended many millions of human lives, and now is resulting in an ever ageing Chinese population, with a gross sex-imbalance. This is nothing to be proud of, or to offer to “share” with other countries, and it is the result of totally unethical and immoral medicine. The research failed to address the often brutal means that the Chinese Government uses to ensure this policy – as mentioned they include forced abortions and sterilisations - or the demographic crisis it is largely responsible for. The Chinese people have made far more than “sacrifices” for the one child policy. They have suffered tremendously for it, and continue to do so. Prof Potts writes about the policy “the root cause of the policy lay back in the 1960s with Mao Zedong's belief that "the more people, the stronger we are"—an ideology that prevented China from developing the highly successful voluntary family planning programmes that countries such as South Korea and Taiwan had put in place in the 1960s.” It is important to note that South Korea’s and Taiwan’s policies were so “successful” that both are currently in a demographic crisis, with far too few young people, and both Governments actively encouraging families to have more children, and even offering financial rewards for them. Prof Potts mentions that parts of India are now enjoying a high growth rate; yet, parts of India are also suffering from a similar demographic crisis to South Korea and Taiwan. There have also been millions of sex-selective abortions in India in the past two decades, and as in China, huge sex imbalances have arose. He also writes “Some western commentators believe China over- reacted”. I feel this a massive understatement of what has happened. The Chinese government has forced many women into forced abortions and sterilizations; the exact figure is difficult to obtain. This is more than “over-reaction”; this is an outrage and a total violation of human rights. Yet these blatant and constant violations of human rights by the Chinese authorities are barely mentioned in Professor Potts’ editorial, or the research. Within the past few weeks, highlighting these abuses even more, Chen Guangcheng, the blind activist who exposed a massive forced abortion and sterilization in Linyi, China, has been put on trial for his campaigns against the “population control” policies of the Chinese Government. Yet, despite the evidence, Prof Potts says that China’s “contribution to international family planning could prove an important additional global benefit”. A benefit to whom? cameron.mclarty@hotmail.co.uk Competing interests: None declared |
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Aruna Reddy Gurrala, SHO in Anaesthetics University Hospitals of Leicester, LE1 5WW, Chandrakant Gosavi
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We don’t share the same view as Prof Potts on china’s one-child policy. Prof Potts undermined the impact of this policy on Chinese people’s mental and social health. 1 China's one child policy was established by Chinese communist regime in 1979 to limit communist China's population growth. Although designated a "temporary measure," it continues a quarter-century after its establishment and China has proclaimed that it will continue this policy, through the 2006-2010 five year planning period .2 The policy which limits couples to one child has caused a disdain for female infants; abortion, neglect, abandonment, and even infanticide have been known to occur to female infants .2 The effect of the policy on the sex ratio has received much attention. The sex ratio at birth, defined as the proportion of male live births to female live births, ranges from 1.03 to 1.07 in industrialized countries. Since the onset of the one-child policy, there has been a steady increase in the reported sex ratio, from 1.06 in 1979, to 1.11 in 1988, to 1.17 in 2001.3 The Chinese government has acknowledged the potentially disastrous social consequences of this sex imbalance. The shortage of women may have increased mental health problems and socially disruptive behavior among men and has left some men unable to marry and have a family. The scarcity of females has resulted in kidnapping and trafficking of women for marriage and increased numbers of commercial sex workers, with a potential resultant rise in human immunodeficiency virus infection and other sexually transmitted diseases. There are fears that these consequences could be a real threat to China's stability in the future.3 The other issue with this policy is the percentage of the population over the age of 65 years was 5 percent in 1982 and now stands at 7.5 percent but is expected to rise to more than 15 percent by 2025. Due to inadequate pension coverage financial dependence on offspring is still necessary for approximately 70 percent of elderly people. In China, this problem has been named the "4:2:1" phenomenon, meaning that increasing numbers of couples will be solely responsible for the care of one child and four parents.3 The one-child policy does not allow families to decide how large they will be, but imposes controls top-down. If they do not comply they can be arrested, or the women even forced to have an abortion. This is illegal, and inhumane. 4 We think China has to find a slightly kinder policy, which is based on education, rather than this tough and cruel approach they have now. Reference: (1) Potts M. China’s one child policy. BMJ 2006; 333: 361-2 (2) Designed to limit population growth http://geography.about.com/od/populationgeography/a/onechild.htm (accessed on 29th August 2006) (3) Hesketh T, Lu L, Xing ZW. The effect of china’s one-child family policy after 25 years. N Engl J Med 2005;353: 1171-6 (4) China’s one-child policy http://www.rfa.org/english/news/social/2004/10/14/china_one_child_policy/ (accessed on 29th August 2006) Competing interests: None declared |
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James G. Danaher, retired NHS GP 33 Ashby Road, Ravenstone, Coalville, Leicestershire, LE67 2AA
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Malcolm Potts notes that ‘the whole of sub-Saharan Africa, along with Pakistan, Iraq, Afghanistan, and the Philippines, have population growth rates of at least 2%’ Readers may like to know how this population growth rate translates into numbers of people. The figures from the United Nations can be found at http://esa.un.org/unpp Uganda, which is the same size as the United Kingdom, had a population of 5 million in 1950; 24 million in 2000; and an estimated 113 million in 2050. Pakistan had a population of 37 million in 1950; 142 million in 2000; and an estimated 259 million in 2050. The population of Africa plus the Middle East to Pakistan was 306 million in 1950; 1,151 million in 2000; and an estimated 2,320 million in 2050. Few people are interested in these demographic changes, one of the great events of human history, and most people remain serenely unconcerned about a population increase south and east of the Mediterranean of 1000 million every 50 or 60 years. I wonder why this is? Gerald Danaher (Retired NHS GP) gdanaherg@aol.com Competing interests: None declared |
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Rachel Joyce, Acting Director of Public Health Bedfordshire Heartlands PCT, 1-2 Doolittle Mill, Froghall Road, Ampthill, Beds, MK45 2NX
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EDITOR - Potts(1) pointed out the serious harm to public health caused by world over-population in terms of education, employment and rates of poverty. What he failed to point out, however, is the at least equal, and possibly irreparable harm that world over-population is continuing to do to the environment. Global warming and climate change are now generally accepted to be caused by human activity, and as the population grows, its effects worsen year on year. Indeed, Lovelock(2) has estimated that the earth's safe maximum population should be only half to one billion people. The methods used by China to control its population growth may not be acceptable to the Western World, but other more politically acceptable strategies have been shown to work. What IS clear, however, is that population growth is the world's biggest challenge to public heath and the environment, and action needs to taken to address this by the international community now. (1)Potts, M. China's one child policy. BMJ 2006;333:361-2. (2)Lovelock, J. The revenge of Gaia. Penguin (London),2006. Competing interests: None declared |
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Gregory Gardner, Associate General Practitioner Cape Hill Medical Centre, Raglan Rd., Smethwick B66 3NR
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Malcolm Potts argues in a BMJ editorial (Aug 19th) that the Chinese one child per family policy is ‘one of the most important social policies ever implemented.’ Important to whom: its victims or the population controllers? The ‘one child policy’ where women have been subjected to forced abortions and sterilizations; children born without a state authorization permit have no access to education, health or employment;[1] and where sometimes husbands have been tortured or imprisoned in order to gather information is a massive catalogue of human rights abuses. In testimony before a committee in the U.S. House of Representatives (1998), Gao Xiao Duan, a former administrator of a planned birth office related the following story to the hearing: ‘Once I found a woman who was nine months pregnant, but did not have a birth-allowed certificate. According to the policy, she was forced to undergo an induced abortion. In the operating room, I saw the child's lips were moving and how its arms and legs were also moving. The doctor injected poison into its skull and the child died and it was thrown into the trash can. Afterwards the husband was holding his wife and crying loudly and saying, "What kind of man am I? What kind of husband am I? I can't even protect my wife and child. Do you have any sort of humanity?’[2] China has a national suicide rate three times the global average.[3] Unusually the suicide rate is greater in women than in men and is the leading cause of death in the 15-34 age group.[4] An association between abortion and suicide is now recognised.[5] The amount of death and pain perpetrated by population control ideology is far greater than is realised. [1] http://www.c-fam.org/pdfs/unfund.pdf [2] http://www.eugenics-watch.com/roots/chap15.html [3] Lee, S. In China, suicide in young women is a problem too. BMJ 2000;321:636. [4] Phillips MR, Li X, Zhang Y. Suicide rates in China, 1995-99. Lancet 2002;359:835-40. [5] Gissler M, Berg C, Bouvier-Colle MH, Buekens P. Injury, deaths, suicides and homicides associated with pregnancy, Finland 1987-2000. Eur J Public Health 2005;15:459-63. Competing interests: None declared |
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Gregory Gardner, Associate General Practitioner Cape Hill Medical Centre, Raglan Rd., Smethwick B66 3NR
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Professor Potts claims that the United Nations Population Fund has never supported the one child policy.[1] This is not true. The Chinese government and UNFPA signed a ‘memorandum of understanding’ in 1978.[2] This was followed by UNFPA’s first 50 million dollar grant to China in 1979. Between 1979 and 1982 UNFPA’s experience in information gathering and statistical analysis was crucial for China to put together this comprehensive piece of social engineering. UNFPA has consistently been its number one apologist and ideological supporter. In 1983 it gave the ‘United Nations Population Award’ to Qian Xinzhong, minister of the Chinese State Family Planning Commission. In the same year, the International Planned Parenthood Federation a sister organisation to UNFPA declared the goals of the Chinese programme ‘entirely consistent with its own.’ On January 30th 2006 the UNFPA put out a statement approving ‘the sixth UNFPA programme of assistance to China, totalling $27 million over five years.’[3] The U.S. Secretary of State decided to de-fund UNFPA because it was ‘helping improve the administration of the local family planning offices that are.…effectively coercing women to have abortions.’[2] In 2001 undercover investigators located the desk of the U.N. administrator of the UNFPA county program in Sihui. That desk, which investigator Josephine Guy photographed, was in the same office as the Chinese officials who enforce the one-child policy in that UNFPA program. A short distance from that office, in a county where UNFPA told Congress coercion had ended, Miss Guy obtained over two dozen testimonies from witnesses and victims who said that coercion was as bad today in this UNFPA program as ever in the history of the one-child policy. Statements came from several people who were imprisoned, fined heavily and had their homes destroyed for attempting to hide the pregnancy of a Chinese woman.[4] [1]Potts, M. China's one child policy. BMJ 2006;333:361-362 [2] http://www.c-fam.org/pdfs/unfund.pdf [3] http://pop.org/main.cfm?EID=908 [4]http://pop.org/main.cfm?id=216&r1=1.00&r2=3.00&r3=95.00&r4=5.00&level=4&eid=512 Competing interests: None declared |
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