Family size, fertility preferences, and sex ratio in China in the era of the one child family policy: results from national family planning and reproductive health surveyBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38775.672662.80 (Published 17 August 2006) Cite this as: BMJ 2006;333:371
All rapid responses
Dwindling ratio in India
Dr Charu Chanana, M.D
Similar to the Chinese government, the government of India had
adopted a policy of two children per couple, which was later modified to
the one child norm so as to keep a check on the ever-increasing
But till date the population is nowhere even near control and the
ratio seems to be more and more imbalanced as the time passes. In many
villages of the country marriages occurs much before the years
for males and 18 years for females that has been set by the law. At
least 5 to 6 children are borne by each couple .The general feeling is
more kids, more hands, more income. The scenario is not different in
cities. Here the total number of children born to a couple may be less but
at the cost of female feticide (inspite of a law against prenatal
determination). Recently the Indian newspapers had news of many female
fetuses being found in a well.
It seems still many years before this scenario will change. The only
hope towards this seems to be female education because it is rightly said
that by educating a man you educate a person but by educating a female you
educate an entire family
Competing interests: No competing interests
The study by Ding and Hesketh (1) shows that finally also political
Chinese authorities and researchers recognize a phenomenon which has been
clear since long time. The imposition to Chinese women to give birth to no
more than one child has determined a fast reduction of the countriy's
fertility rate. This reduction, in societies where a cultural preference
for male children exists, causes an alteration in sex ratio (SR), as other
countries' experiences show, in which the reduced fertility rate was
determined not by regulations but by other social or economic factors (2-
4). A study carried out a few years ago on an entire population of Chinese
children born overseas to recent Chinese immigrant couples had shown that
the cause of the altered SR in China motherland was the One-Child Family
Policy (OCFP) (5). Immigrant Chinese women, indeed, had full freedom in
reproductive choices, full assistance during pregnancy, free ultrasound
check and free abortion choice with no costs for them, but SR during a ten
year period resulted normal. It is important that Chinese authorities are
gathering data about some of the phenomenon that OCFP has determined.
However they should also commit themselves to examine two major
consequences of OCFP.
The first one is that the abnormal sex ratio at birth means that an
alarmingly high number of men -it has been hypothesized, 1 million per
year (6)- will not have a female partner in the next years. Chinese
researchers and the government should focus their attention on the
possible socially disruptive consequences of this phenomenon, which does
not have precedents in human history -on the opposite, a surplus of women
was reported after long periods of war. Western researchers who studied
this phenomenon hypothesized that this might represent a risk for internal
public order but also for international security (7)
The second relevant consequence of the fertility rate's drop caused by
OCFP is an alarming disparity of numbers between one generation and the
next. Like in many other countries, in China too population is quickly
aging. The old age dependency ratio (i.e. the ratio of over 65s to the
working age population) is increasing (8) and at the half of this century
elders will be a quarter of Chinese population. At the same time longevity
increases, as does morbidity, and the pension system covers only a small
part of the elders, who have, therefore to rely on their relatives' care.
The Law of 1979 aimed at a society made up of one-child families but did
not plan how the only child, together with his/her spouse, would support
up to four parents, eight grand-parents -and an only child. The social
consequences of this potentially disproportionate burden for young Chinese
families deserves the attention of Chinese researchers.
The OCFP loosened the demographic pressure on China but created new
relevant problems which involve society and public health and which have
not been sufficiently studied. The OCFP has determined a sort of
"demographic bonus" for China which helped the country's dramatic economic
development:. It is urgent that the resources determined by this bonus are
transformed in investments in public health and in an effective pension
1- Ding QJ, Hesketh T. Family size, fertility preferences, and sex
ratio in China in the era of the one child family policy: results from
national family planning and reproductive health survey. BMJ 2006;333: 371
2- Gu B, Roy K. Sex ratio at birth in China, with reference to other
areas in East Asia: what we know. Asia Pac Popul J 1995;10:17–42.
3- Jha P, Kumar R, Vasa P, Dhingra N, Thiruchelvam D, Moineddin R.Low
female-to-male sex ratio of children born in India: national survey of 1.1
million households. Lancet. 2006;367:211-8.
4- Lee J, Paik M.Sex preferences and fertility in South Korea during
the year of the Horse. Demography. 2006;43:269-92.
5- Festini F, Taccetti G, Repetto T, Cioni ML, de Martino M. Sex
ratio at birth among Chinese babies born in Italy is lower than in China.
J Epidemiol Community Health. 2003;57:967-8.
6- Tuljapurkar S, Li N, Feldman MW.High sex ratios in China's future.
7- Hudson vM, den Boer AM. Bare Branches: The Security Implications
of Asia's Surplus Male Population. BCSIA Harvard University. 2004.
8- Sun F. Ageing of the population in China:trends and implications.
Asia Pac Popul J
Competing interests: No competing interests