China: Part 2 Family size, fertility preferences, & sex ratio in the one child family policy era Print E-mail

  2006;333:371-373 (19 August)

 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 [continued)

 Read Part 1

It is not clear how much these demographic changes are due to the one child policy. Many countries are seeing decreases in fertility rates, and neighbouring east Asian countries have some of the lowest total fertility rates in the world: 1.38 for Japan, 1.04 for Singapore, and 0.91 for Hong Kong.15 Thus the fertility rate may have continued to fall from the 2.9 seen in 1979 even without the one child policy. Likewise many other Asian countries that have declining birth rates and traditional preferences for male babies are seeing serious sex imbalances: 1.19 for Taiwan, 1.18 for Singapore, 1.12 for South Korea, and 1.20 for parts of northern India. 16 Even without the policy, sex selective abortion would be likely to continue, although it would probably be less common. This can only be solved by a change in attitudes towards female offspring. Our finding that many younger women in urban areas now express a preference for girls provides evidence that attitudes may be changing.

Since the start of the one child family policy, the total birth rate and the preferred family size have decreased, but a gross imbalance in the sex ratio has also emerged. These findings have clear implications for decisions about future population policy. A relaxation in the policy could be considered in the near future. Recommendations that all couples should be allowed to have two children, but not more than two, have already been made.3, 17 It is unlikely that a baby boom would result, and such a change in policy might help to correct the abnormal sex ratio. 

What is already known on this topic
The one child family policy has been in force in China since 1979 and was intended as a short term measureWhat is already known on this topic
The one child family policy has been in force in China since 1979 and was intended as a short term measure

Contributors: QJD was part of the team that designed the study and assisted in data collection in Zhejiang Province. QJD and TH analysed the data and TH wrote the paper. QJD and TH are guarantors.  

Funding: None.
Competing interests: None declared.
Ethical approval: National Family Planning Commission standards committee.


1. Zhu WX. The one child family policy. Arch Dis Child 2003;88: 463-4.

2. Li J. Gender inequality, family planning and maternal and child care in a rural Chinese county. Soc Sci Med 2004;59: 659-708. [CrossRef]

3. Greenhalgh S, Bongaarts J. Fertility policy in China: future options. Science 1987;235: 1167-72.

4. Merli MG, Raftery AE. Are births underreported in rural China? Manipulation of statistical records in response to China's population policies. Demography 2000;37: 109-26. [ISI] [Medline] 

5. Goodkind DM. China's missing children: the 2000 census underreporting surprise. Popul Studies 2004;58: 281-5.

6. Yao XW, Yin H. Basic data of China's population. Beijing: China Population Publishing House, 1994. 

7. Retherford RD, Choe MK, Chen J, Li X, Cui H. How far has infertility in China really declined? Popul Dev Rev 2005;31: 57-84.

8. Winkler EA. Chinese reproductive policy at the turn of the millennium: dynamic stability. Popul Dev Rev 2002;28: 379-418. 

9. Davis DL, Gottlieb MB, Stampnitsky JR. Reduced ratio of male to female births in several industrial countries. JAMA 1998;279: 1018-23.

10. Sen A. Missing women­revisited. BMJ 2003;327: 1297-8.

11. 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.

12. Coale A, Banister J. Five decades of missing girls in China. Demography 1994;31: 459-79.

13. Bogg L. Family planning in China: out of control? Am J Public Health 1998;88: 649-51.

14. United Nations Development Program (UNDP). Human development indicators in world development report 2003. http://hdr.undp/org/reports/global/2003 (accessed 1 Sep 2005).

15. World Bank Health Nutrition and Population Division. Development data 2004. (accessed 1 Sep 2005).  

16. Hesketh T, Li L, Zhu WX. The effect of China's one-child family policy after 25 years. N Engl J Med 2005:353: 1171-6.

(Accepted 8 November 2005)