Natalist policies: a new challenge for sexual and reproductive health and rights? The example of China.
The thirtieth anniversary of the International Conference on Population and Development in Cairo (1994), scheduled for October 2023, invites us to take a critical look at the implementation of the Programme of Action adopted on that occasion. This plan brought about a major paradigm shift in demographic concerns from a logic of birth control to a focus on sexual and reproductive health and rights (SRHR). It also contributed to broadening the definition of SRHR beyond family planning, health during pregnancy and childbirth mortality, to include women's health throughout their lives, and in particular the issue of violence against women. Following this position, UNFPA states that "parents have the exclusive right to determine freely and responsibly the number and spacing of their children". The logic behind SRHR reaffirms the right of every person "to exercise full control over the basic aspects of her or his private life - body, sexuality, health, relationships, freedom to marry or not, to have or not to have children, and where appropriate, to choose the time and partner [...]".
China, a signatory of the Programme for Action, has achieved remarkable progress over the past thirty years, significantly reducing the rate of childbirth deaths. Simultaneously, China has seen its fertility rate decline dramatically. Following the latest decennial census showing a further decrease in fertility rates, the Chinese government decided to complete its shift to a pro-natalist strategy, announcing the three-child policy in August 2022. What does China's pro-natalist turn mean for the respect of women's sexual and reproductive health and rights? Whilst some commentators have welcomed the extension of birth permits which allows parents to choose whether to have one, two, or three children, a broader understanding of China's pro-natalist policy suggests yet another instrumentalisation of women's reproductive functions and the undermining of SRHR.
The one-child policy: Rise of state control over women's bodies
The first population planning effort emerged as early as 1955 under the leadership of Mao. The Chinese Communist Party (CCP) viewed production and reproduction as dialectically interdependent which entailed that both should be the focus of government planning. This "collectivisation" of reproduction was enshrined in law with its inclusion in the new Constitution of 1978. The one child policy launched two years later was difficult to implement throughout the country and it triggered strong resistance in rural areas where circumvention techniques flourished. Some parents even resorted to selective abortion, infanticide, or the mistreatment of girls at birth. Discrimination against daughters is widespread in China and, combined with the one-child policy, has contributed to the phenomenon of "missing girls" that still afflicts the country today.
The first decades of anti-natalist policy were detrimental to the respect of SRHR. In addition to the rise in violence against girls, women generally bore the responsibility for birth planning at the expense of their mental and physical health. Forced sterilisation and abortions increased, while family planning programmes mainly promoted female contraception by IUD or tubal ligation. However, researchers have shown that the type of IUD used in China in the 1980s and 1990s, especially in women in their twenties, has resulted in many health problems later on. The one-child policy mainly targeted women to achieve the country's demographic and economic goals. This instrumentalisation of women's reproductive functions paved the way for coercion to the detriment of respect for SRHR.
The shift to pro-natalist policies: state renewed commitment to control women’s reproductive functions
In response to the sharp decline in fertility, the CCP introduced the two-child policy in 2016. Despite a lack of results from this first attempt, the three-child policy was announced in 2021. The new law declares: “The state advocates marriage and childbirth at an appropriate age as well as better childbirth and childcare. A couple can have three children.” (Article 18) The law seemingly embraces a shift towards voluntary family planning with an extensive set of social protection measures. Yet, it takes the controversial stand to extend birth permits rather than putting an end to birth planning altogether. In the context of Xi Jinping's renewed authoritarianism, this decision suggests a continued commitment to using disciplinary power to control the population.
Comparatively to the previous versions of the law, the emphasis shifted more specifically to the alleged causes of the decline in fertility: the population problem is not only defined by the number of children allowed but by the age of marriage and childbearing. According to the law, the “population problem” would be less of a problem if couples were marrying and having children at an “appropriate” age – meaning younger. Additionally, the new law emphasises binaries and categories inherited from demographic surveys, thus participating in a shift in fertility responsibility from men and women to women. Significantly, it distinguishes “women of childbearing age” and uses biological characteristics to define women’s bodies as a legitimate focus of state intervention. By categorising subjects in a hierarchy of reproductive practices, the policy reminds women between 21 and 35 of their reproductive duties and indicates the “right” behaviour.
This law confirms and reinforces a representation of the demographic problem already widespread in Chinese media: young women postponing their marriage and first child are responsible for the demographic decline and should therefore bear the responsibility for the pro-natalist policy. This shift towards pro-natalism builds on an official campaign launched in 2007 that portrays single women over 27 as "leftover women", left behind and unable to find a husband. By stigmatising this group, the Chinese government is using gender stereotypes embedded in the collective imagination to encourage "quality" (educated, young, urban) women to marry and have children. This campaign has led many women to sacrifice their careers, rush into marriage and tolerate abusive relationships. The three-child policy demonstrates a continued commitment to control women’s reproductive functions, which constrains women’s autonomy to make reproductive decisions.
Undermining women’s reproductive and sexual health and rights
The three-child policy not only reinforces the instrumentalisation of women's bodies but also undermines their reproductive rights. In May 2021, an online crackdown targeted Douban accounts suspected of spreading the ideas of the feminist movement "6B4T". Born in South Korea, this movement notably opposes marriage and motherhood, in a general rejection of gender stereotypes. But this political commitment to sacrifice reproductive rights in the name of economic concerns has gone further. One month after the official adoption of the three-child policy, the CCP published a "Programme for the Development of Chinese Women (2021-2030)" announcing, in a paragraph on reproductive health, that abortions for non-medical reasons should be reduced. The rise in abortion rates is deemed alarming as it contributes to the decline in fertility.
China's pro-natalist turn has also resulted in a new limitation to the right to divorce. Out of fear of the demographic crisis, the CCP began to tackle the divorce rate by introducing a mandatory “30-day cooling-off period." While this measure is not unique to China, it has to be understood in a context where the right to divorce is often denied in practice. Significantly, between 2000 and 2008, the proportion of divorce requests granted by court adjudication declined dramatically from 70% to 35%. The turn to low-fertility concerns is underpinning the judges’ decisions to quasi-systematically reject divorce petitions when they are filled for the first time, especially if there is no mutual consent, and even with evidence of domestic violence. The argument usually put forward is that mutual affection persists in the relationship and that there is a possibility for reconciliation. There is then a one-year delay before it is possible to start a new divorce procedure. In a society where family harmony and stability are particularly valued, this phenomenon contributes to endangering women victims of abuse. It also pushes them to give up property rights or even the custody of their children to obtain a mutual divorce. The introduction of a “cooling-off period” creates further uncertainty for these women who have secured their husband's consent to divorce but could now fear a withdrawal of that agreement for 30 days.
Global demographic issues: a new obstacle to the respect of SRHR?
As demographic decline affects an increasing number of countries around the world, the Chinese case illustrates the potential dangers of a pro-natalist policy. By instrumentalising women's bodies for demographic and economic purposes, the three-child policy justifies violations of women's SRHR. Yet the solution to population issues advocated by the Chinese state is not the only one. This approach has been developed consistently with the nationalist and repressive ideology embodied by Xi Jinping. It focuses exclusively on national fertility at the expense of other policy options such as immigration. Even at the national level, the birth control policy establishes a clear hierarchy between different groups by encouraging the fertility of the predominantly Han population while resorting to forced sterilisation of Uyghur women.
Amongst the most developed countries, two-thirds of governments already believed in 2015 that the national fertility rate was too low and were implementing policies to encourage births. Today, almost half of the world's population lives in a country with a total fertility rate below the estimated replacement level of 2.1 children per woman. The global pandemic has shown the vulnerability of SRHR in times of crisis, and fears of population decline could open the door to widespread violations of reproductive rights. It is therefore imperative to reaffirm the centrality of SRHR in family planning policies by considering women's reproductive health not as a means to achieve demographic, economic, or political goals, but as a desirable end in itself.